Bat Mitzvah Club Registration

We are currently accepting application forms for the 2022-2023 Bat Mitzvah Club. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please email Leah [email protected] or call 646-575-0988.

Student's Name*

First NameLast Name

Hebrew Name*

Birth Date*

MonthDayYear

Was your daughter born after nightfall?*

YesNo

What school does your daughter attend?

Grade Entering

Synagogue Affiliated with

Address*

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

Any conversions or adoptions in the family? If yes, please explain*

Is the child's mother Jewish?*

YesNo

Father's Full Name*

First NameLast Name

Father's Phone Number*

Area CodePhone Number

Father's E-mail*

Marital Status

MarriedSeparatedDivorced

Mother's Full Name*

First NameLast Name

Mother's Phone Number*

Area CodePhone Number

Mother's E-mail*

Emergency Contact

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Emergency Contact 2

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Who referred you to Bat Mitzvah Club?

Does your daughter have any allergies, other medical conditions or special needs we should be aware of?

YesNo

If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Bat Mitzvah Club to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Bat Mitzvah Club personnel will try, but are not required, to communicate with me/us prior to such treatment. I/we hereby give permission for my/our child to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child to be photographed while participating in Bat Mitzvah Club activities. I/we also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my/our child/children will be my/our responsibility and I/we agree to fully indemnify and save Bat Mitzvah Club and it’s associates, teachers and agents harmless therefrom. I/we consent to Hallandale Bat Mitzvah club use of our personal information and of our child/children at its discretion in pursuit of school activities.

Initials & Date

Fee: $770 (includes registration fee)

This is non-refundable and due in full at the time of registration.

Location: 1295 E. Hallandale Beach Blvd, Hallandale beach, FL 33009

Sunday 10:15 AM - 12:00 PM

Registration must be paid in full at time of registration.

Payment Options

Pay in full3 payments

Payment

Credit Card Check or cash

Postal / Zip Code

Country

Please make all checks payable to Hallandale Hebrew Club and submit them together with the registration form.

There are no refunds or credits for days missed due to illness, holidays, or family vacations.

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