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Youth Zone Bat Mitzvah Club

Bat Mitzvah Club Registration

Please use this form to register your daughter for Bat Mitzvah Club. Meetings will be held once per month on Sundays. We look forward to learning with your daughter!
The dates are:
September 22
November 3
December 8
Jan 12
Feb 9
March 8
April 26
May 5
Child's Name*
First NameLast Name
Child's Birthdate*
MonthDayYear
School in Fall 2019*
Parent's Name*
First NameLast Name
Parent's Email*

Address*

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

Parent's Cell Phone*
Area CodePhone Number
Emergency Contact (in case parent can't be reached)*
First NameLast Name
Emergency Contact Number*
Area CodePhone Number
Does your child have any allergies or food/activity restrictions?
Annual Tuition: $180
$180

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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