Bar Mitzvah Club Registration

Student Info
Name   Hebrew Name
DOB   Hebrew DOB
Public School   OHIP #
Entering Grade   Date of Bar Mitzvah
Address   City, State, Code
Phone   Email
Other Important Information, educational, personal or medical  


Father's Info   Mother's Info
Father's Name   Mother's Name
Father's Hebrew Name   Mother's Hebrew Name
Mobile #   Mobile #
Occupation   Occupation
Company   Company
Address (if different from student)   Address (if different from student)


Synagogue Affiliation  Member Yes No
Is the natural mother of this child Jewish? Yes No
Were there any coversions or adoptions in your family? Yes No
If Yes, please explain 
Please Note: All conversions must be in accordance with Orthodox Halachic Standards.



Emergency Contact
Relationship to Child
Telephone Number
Relationship to Child
Telephone Number

I confirm the enrolment of this child, and I permit this child to participate in all school activities, join in class and school trips on and beyond school properties. In case of an emergency, I hereby authorize the school to have my child taken care of by a physician in any way the situation may call for.
Parent  Name     Date



Total Tuition Fee: $200 

The Bar Mitzvah Club fee is based on bi-weekly classes and includes all course material and supplies. It does not include the private Bar Mitzvah lessons.


Please fill out the following:

Credit Card:
Credit Card Number:
Expiration Date:
Security Code: