Bar Mitzvah Club Registration Form

Students Name*

First Name Last Name

Hebrew Name*

Date of Birth*

Month Day Year

Date of Bar Mitzvah*

Month Day Year

Address*

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

Phone Number*

Area Code Phone Number

Child's E-mail if applicable

School Attending*

Previous Hebrew School experience*

Mothers Name*

First Name Last Name

Hebrew Name

E-mail*

Phone Number*

Area Code Phone Number

Jewish*

Father Name*

First Name Last Name

Hebrew Name*

Phone Number*

Area Code Phone Number

E-mail*

Jewish*

Allergies

Any medical history or condition that Bar Mitzvah Club should be aware of?

Emergency Contact* Parents will always be contacted first. In case of emergency, if parents can not be reached, please provide an additional contact who can be notified.

First Name Last Name

Phone Number*

There are more JRCC Bar Mitzva Club locations with different timing out of our Richmond Hill/Maple community, as well as private lessons available upon request.

Please contact me to discuss alternative timing or private instruction options.

*

Yes, I am registering my son for Bar Mitzvah Club, and agree to pay the $100 mandatory deposit. (will come off total tuition cost)

Total

$100.00

*

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 is $1,250 for the entire year. A $100 non-refundable deposit fee will be charged upon registration, and will be deducted from the tuition balance.

First tuition payment is due by September 15th 2024 and can be spread out to up to five Payments (until January 15, 2025).

Tuition Payment Options*

One time credit card paymentCredit card payments : First Payment $100 non-refundable fee. Balance in up to 5 installments - using the card I submitted above. (Please outline your preferred breakdown in the notes below.)Cheque: Balance in up to 5 postdated cheques

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

Tuition Receipt Preference*

Tuition Scholarship Please understand that the scholarship will depend on your submission of the application to UJA in a timely fashion. JRCC Hebrew School will charge client a minimal $50 tuition per month starting October 1 if the scholarship approval is delayed for any reason. In the event of any overpayments, client will be refunded after the scholarship is determined.

I would like to apply for the UJA Part-Time Jewish Education Tuition Scholarship and I request that the application be sent to me.

Discount Code

I would like to assist a child who cannot afford Bar Mitzvah Education

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of JRCC Bar Mitzvah Club to hospitalize or secure treatment for my/our child, if an emergency arises. I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, JRCC Bar 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 Bar 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.

*

I have read, understand and agree to the Hebrew School liability waiver above.

Type in your signature*

Date*

Month Day Year

Bar Mitzvah Club Registration Form

Student Information

Parents Information

Student Medical Information

Payments & Fees

Consent

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