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Bar Mitzvah Club

Bar Mitzvah Club Registration

Bar Mitzvah Club Registration
Child's Full Name
First NameLast Name
Child's Birth Date
DayMonthYear
Child's School
Child's Grade (2020)

Child's Address

Street Address
Street Address Line 2
City	State
Post Code	Country

Does your child take any medications?
Does your child have any allergies?
Tell us about your child:
Mother's Details
Mother's Full Name
First NameLast Name
Mother's Phone Number
Area CodePhone Number
Mother's Email
Is the natural mother of the child Jewish?
YesNo
Are there any conversions in the family?
YesNo
Father's Details
Father's Full Name
First NameLast Name
Father's Phone Number
Father's Email
Emergency Contact Details
Emergency Contact's Full Name
First NameLast Name
Relationship to Child
Emergency Contact's Phone Number
Emergency Contact's E-mail
Payment Details
Name on Card
Number on the Card
Expiry Date
CVV
Should be Empty: