Printed fromChabadofCobb.com

Bat Mitzvah Club

ב"ה

BMC Registration Form

Who: All 6th Grade Girls!

When: Club meetings take place once a month on Sunday evenings from 7:00-8:30. There is also a beautiful Friday Night Shabbat Dinner during the year.

Where: All Club Meetings take place at Chabad of Cobb

*There is a $150.00 fee (includes all sessions, supplies and snacks)
Parent Information:
Mother's Full Name:* First and Last
Mother Jewish?*

YesNo
Mother's E-mail*
Mother's Phone Number:*

Area Code Phone Number
Father's Full Name:* First and Last
Father's E-mail:
Father's Phone Number

Area Code Phone Number
Child Information:
Full Name:*
First Name Last Name
Hebrew Name:*
Birth Date:*

Month Day Year
Middle School Attending:*
Grade:*

Family Home Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child's E-mail:
Child's Phone Number:

Area Code Phone Number
Registration & Permissions:
Permission*

I give permission for my daughter to be a member of the Bat Mitzvah Club of Cobb and to attend all activities and outings.
Parent's Signature:*
Payment Information:
Registration Fee*

$150.00
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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