Printed from ChabadWesthempstead.org

Bar Mitzvah Club Online Registration Form

Bar Mitzvah Club Online Registration Form

ABOUT SCHEDULE PHOTOS REGISTER
Click here to print and download the regisration form
First Name
Last Name
Age
School
Address
City/Zip
Phone Number
Parents Email Address
Mother Cell Number Father Cell Number
Emergency Contact #
Allergies (if any)
Hebrew Name
Birthday
Comments

The cost to enroll is $180.00 for the Bar Mitzvah Club program

Please choose one of the following payment plans

Payment in full $180

2 installments of $90 (with head checks)

I will pay by Check Credit Card

Name on card
Credit card type
Card number
Security code
Expiration month Expiration year
Total amount to be charged

Comments
Please check if you would like to sponsor another child for this club
A project of Chabad of West Hempstead
565 Nassau Blvd • West Hempstead, NY 11552 • 516-483-1683
Email:
chayarochel@yahoo.com

Secure This page uses 128 bit SSL encryption to keep your data secure.