Registration - JewishFairfield.org

Bat Mitzvah Club Registration
Parent's Information:
Father's Name:*

First Name Last Name
Father's Cell:

Area Code Phone Number
E-mail:
Mother's Name:*

First Name Last Name
Mother's Cell:

Area Code Phone Number
E-mail:
Applicant's Information:
Girl's Name:*

First Name Last Name
Hebrew Name:*
Birth Date:*

Month Day Year
School Currently Attending:*
Previous Jewish Education:*
Current Grade:*
CONFIDENTIAL: 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.
Payment:
Payment Options:*

Pay Tuition in Full Now: $200 Pay $100 now and $100 on February 1, 2022 Please send me info on financial assistance.
Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

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Postal / Zip Code

Country

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Bat Mitzvah Club