Bat Mitzva Club Registration

Please fill out the form below carefully. When you press submit, this form (secure form) will be sent to our administration office.

|Student Information

Full Name*

First Name Last Name

Jewish Name*

Child's email (if applicable)

Address*

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

Phone Number*

Area Code Phone Number

Birthday*

Month Day Year

at Hour Minutes

School Attending*

Hebrew School attended in the past

Grade as of Sep 2024*

Allergies or any medical condition we should be aware of

|Parental Information

Marital Status*

MarriedDivorcedSeparated

Father Information

Full Name*

First Name Last Name

Hebrew Name*

Occupation

Mobile*

Area Code Phone Number

Work Phone

Area Code Phone Number

E-mail*

Father's Jewish Identity*

yesno

Mother Information

Full Name*

First Name Last Name

Hebrew Name*

Occupation

Mobile Phone*

Area Code Phone Number

Work Phone

Area Code Phone Number

E-mail*

Mother's Jewish Identity*

yesno

|Payment Information

Tuition fees: $950. ($100 of it paid upon registration.)

Tuition fee

$950I'd like to apply for scholarship

$100 Registration Fee Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

CVV*

Tuition Payment Options (for remaining $850 tuition)*

One time credit card payment in SeptemberCredit card payments in up to 5 installments - using the card I submitted above. (Please outline your preferred breakdown in the notes below.)Cheque (up to 5 post-dated payments.)

Please outline your preferred payment plan of up to 5 installments, paid in full by Jan 1, 2025. We will contact you to confirm.

I would like to assist a young girl who cannot afford Bat Mitzvah Club

|Consent

I/We hereby register my child in JRCC Bat Mitzvah Club.

Our club will be meeting Sundays throughout the year. See calendar for details.

I/We give my child permission to participate in all club activities and trips.

The student, as well as his parents or guardians, agree to abide by the rules and regulations set forth by the club.

Photos may be taken and used for future advertising.

I/We understand that JRCC does not assume responsibility for any injury, and in case of emergency necessary medical attention may be secured by the JRCC.

I/We confirm that all the details provided above are accurate, to the best of my knowledge, and if it becomes apparent that some of the provided information is inaccurate, it may be grounds to dismiss my child from the Bat Mitzvah Club

I/We understand that due to COVID - 19, JRCC Bat Mitzvah Club, might be forced to run its programs online during the year and it is up to the discretion of the school to decide when the program is online or in person, according to the ministry guidelines and health care authorities. I/We understand that tuition will not reimburse to me/us, if I/we decide to pull out my child from JRCC Hebrew School at any time.

I/We acknowledge that the risks related to COVID - 19 include, but are not limited to, serious personal injury, death, property damage, illness and disease arising from or related to COVID19. I further acknowledge that I am in the best position to assess the impact that COVID-19 may have on the student or on others with whom the Student may transmit.

I/We hereby release and forever discharge the JRCC Bat Mitzvah Club from any and all liability for all loss, damage, expense, injury, death, property damage, illness or disease arising from or Covid 19.

Type your name as a signature*

*

Month Day Year

Bat Mitzva Club Registration

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