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

Tue, May 6 2025
8 Iyyar 5785

Tue, May 6 2025 8 Iyyar 5785

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