Registration for Bat Mitzvah Club

 

Dates: Dec 12th 2010 - May 15th, 2011

Family Name:

Address:

Home Phone:

Parent's Cell Phone :

Child's name:

Child’s Hebrew name:

Grade:

School:

Date of Birth:

Father’s First & Last Name

Mother’s First & Last Name:

Mother's E-mail:

Daughter's E-mail:

Does you child read basic Hebrew? None Somewhat Well

Does your child speak/understand Hebrew? None Somewhat Well

Does your child have previous Jewish Education? Yes No

The Cost for the Bat Mitzvah Club is $80.00

Form of Payment

Card Number
Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2009 2010 2011 2012 2013 2014		Security Code

I will pay by check

(Please remit check to Chabad of Westborough, 54 South St, Westborough, MA 01581, and memo "Bat Mitzvah Club.")