BMC Registration

Bar/Bat Mitzvah Club Registration
If you have any questions or concerns you would like to discuss with us, please feel free to call us at please feel free to call us at 760-806-7765 or email [email protected]
I am registering...*
Child's Information
Full Name*

First Name Last Name
Birth Date*

Month Day Year

Address*

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

Parent's Information
Father's Name*

First Name Last Name
Father's Cell*
Father's E-mail*
Is the biological father of the child Jewish?*

Yes by BirthYes by ConversionNo
Mother's Name*

First Name Last Name
Mother's Cell*
Mother's Email*
Is the biological Mother of the child Jewish?*

Yes by BirthYes by ConversionNo
Have there been any conversions in your family?*

YesNo
Have there been adoptions in your family?*

YesNo
Emergency Information & Terms
Full Name*

First Name Relationship to the Child Last Name
Phone Number*
Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Terms of Agreement*

As the parent(s) or legal guardian(s) of the above child, I/we authorize any adult acting on behalf of BMC to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, BMC personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in BMC activities and that these pictures may be used for marketing purposes.
Tuition
Tuition: $575 per child (supplies, snacks & book fee included) + $450 Tefillin (Required for boys)

* Every Jewish child deserves a quality education. Please don't hesitate to reach out to us for a scholarship or payment plan that can work for your family. No child will be turned away due to lack of funds.
Tuition: $575 per child (supplies, snacks & book fee included)

* Every Jewish child deserves a quality education. Please don't hesitate to reach out to us for a scholarship or payment plan that can work for your family. No child will be turned away due to lack of funds.
Scholarship Fund
If you are in a position to contribute to our scholarship fund, please consider helping a very deserving child learn about their bar/bat mitzvah.
I would like to make a contribution to the Scholarship Fund in the amount of:

Full Scholarship $575Partial Scholarship $275
Payment Information
Total

$0.00

I would like to pay today:Full amount$100.00 minimum$
If paying just the minimum deposit today:

Please charge the balance in three payments (3 months)As per our discussion, an alternative payment plan has been arranged

Payment

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Postal / Zip Code

Country

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Bar/Bat Mitzvah Club Registration

Child's Information

Parent's Information

Emergency Information & Terms

Tuition

Scholarship Fund

Payment Information