Girl's Information:

Last Name

First Name

Hebrew Name

Father's Name

Mother's Name


Time of birth        AM        PM


Current School

Current Grade

Have there been any conversions in the family? Yes No

If yes, please elaborate:

Tell us a little about yourself...

What are your favourite subjects at school?

What are your favourite activities?

What do you do in your free time?

Names and ages of other siblings

I would like to join the Bat Mitzvah Club because...

 Who would you like to attend BMC with? (if some of your friends registered to our program, we will do our best to place them in the same group as yours)



For Parents:

I am able to host the Bat Mitzvah program in my home Yes No

I am able to volunteer my time to help with driving Yes No


Father's E-mail Address:

Mother's E-mail Address:

Bat Mitzvah Girl's E-mail Address:


Total I am paying*
First Name*
Last Name*
Post Code*
Home Phone*

Card Type*
Card Number*
Expiration Date*
CVV Security Code*