Bar Mitzvah Club Registration

Student Info
Name			Hebrew Name
DOB			Hebrew DOB
Public School			OHIP #
Entering Grade			Date of Bar Mitzvah
Address			City, State, Code
Phone			Email
Other Important Information, educational, personal or medical

Father's Info			Mother's Info
Father's Name			Mother's Name
Father's Hebrew Name			Mother's Hebrew Name
Mobile #			Mobile #
Occupation			Occupation
Company			Company
Address (if different from student)			Address (if different from student)

Other
Synagogue Affiliation	Member	Yes No
Is the natural mother of this child Jewish?		Yes No
Were there any coversions or adoptions in your family?		Yes No
If Yes, please explain
Please Note: All conversions must be in accordance with Orthodox Halachic Standards.

Emergency Contact
Name	Relationship to Child	Telephone Number
Name	Relationship to Child	Telephone Number

I confirm the enrolment of this child, and I permit this child to participate in all school activities, join in class and school trips on and beyond school properties. In case of an emergency, I hereby authorize the school to have my child taken care of by a physician in any way the situation may call for.
Parent  Name     Date

Payment:

Total Tuition Fee: $250  (+$30 Cd Fee for Bar Mitzvah Lessons. Only if you would like.)

The Bar Mitzvah Club fee is based on bi-weekly classes and includes all course material and supplies. It does not include the private Bar Mitzvah lessons.

 

Please fill out the following:

Credit Card:	VISA MasterCard American Express
Amount:
Credit Card Number:
Expiration Date:
Security Code: