Bar Mitzva Club

* Child Last Name

* Child First Name

* Child Date of Birth

* Age

* Grade

* School Attending

* Does your child require a specific accommodation on our part? If so explain.

Allergies/ Medical conditions

* Mother's Name

* Mother's Phone Number

* Mother Jewish Background

Born JewishConvert (please email us your certificate)

Father's Name

Father's Phone Number

* Parent Email

* Please choose one of the options below? (one form per child)

Members

Non- Members

* Which Synagogue are you affiliated with ?

Family Affiliated Rabbi :

* Family Observance Level

Non ObservantTraditionalModern OrthodoxOrthodox

* Emergency Contact (Name and Phone Number)

* Pick up Person Name and Contact

* Relationship to child :

* Waiver

Waiver I agree that B'nai Sephardim cannot be held responsible for any lost or damaged personal items.

I agree that my child's image taken in photos can be posted on B'nai Sephardim sanctioned flyers, WhatsApp groups, or Facebook account.

I acknowledge that pick-up is prompt.

Dates :

My signature and payment acknowledge that my child will be attending the B'nai Sephardim Bar Mitzva Club .

My child will partake in any activities . If my child has any allergies - food will not be provided by B'nai Sephardim and must be sent by the parents.

Total Due

Sat, April 20 2024
12 Nisan 5784

Sat, April 20 2024 12 Nisan 5784