Bat Mitzvah Club Registration

Welcome! We are currently accepting applications for the 2025-2026 school year. Club meetings begin on Sunday, Sep. 14. Meetings are from 10:00 AM - 12:30. If you have any questions or concerns please contact Chana at 347-633-5706.

Mother's Name*

First Name Last Name

Mother's Hebrew Name

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

Mother's Occupation

Father's Name*

First Name Last Name

Father's Hebrew Name

Father's Cell*

Area Code Phone Number

Father's Email*

Father's Occupation

Marital status

Home Address*

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

Home Phone Number

Area Code Phone Number

Are the biological parents and grandparents of the child Jewish?*

Have there been any conversions or adoptions in the family?*

Synagogue affiliated with (if any)

Name*

First Name Last Name

Hebrew Name

Daughter's Phone Number

Area Code Phone Number

Birth Date*

Month Day Year

Time of birth (required to calculate Jewish birth-day)

Hour Minutes

Grade Entering*

School Attending*

Hebrew language ability*

Are there any allergies or other medical conditions we should be aware of ? (CONFIDENTIAL)

Are there any considerations, such as learning difficulties or disorders, that the teacher should be aware of? If yes, please describe them and indicate special precautions or care needed (CONFIDENTIAL)*

What goals do you have for your child attending Bat Mitzvah Club ?*

Tuition per year: $1125 per child + $75 registration & book fee (non refundable). Tuition should be paid in full by registration unless other arrangements are made with the director. You can receive a early bird discount of $75 per family until Aug 20.

Registration Fee*

$75

I would like a early bird discount

$75 off

I would like to pay in full today

Early bird pricing $1050

I would like to pay in full today

Regular Price $1125

I would like to register today. Please contact me regarding a payment plan or for tuition assistance.

Regular Price $1125

Scholarship Fund

Yes! I would like to give the gift of a Jewish eduacation to a family in need

Thanks for ensuring a Jewish future for every child!

Full Scholarship $1200Half Scholarship $600Partial Scholarship $360

Total tuition cost for year

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Paypal Zelle or Check

Postal / Zip Code

Country

AUTHORIZATION
As the parent (s) or legal guardian of the above child/ren, I / we authorize any adult acting on behalf of Mill Basin Hebrew School to hospitalize or secure treatment for my / our child/ren. I / we further agree to pay all charges for that care or treatment. It is understood that if time and circumstances reasonably permit, Mill Basin Hebrew School 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/ren to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child/ren to be photographed while participating in Hebrew School activities, and that these pictures may be used for marketing purposes. 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/ren will be my/our responsibility and I/we agree to fully indemnify and save Mill Basin Hebrew School and its associates, teachers and agents harmless there from. I/we consent to Mill Basin Hebrew School’s use of our personal information and of our child/children at its discretion in pursuit of school activities.

*

I agree to the above

Parent Signature*

Do you have any questions or concerns?

IMPORTANT!
Please note: Acceptance to BMC is dependent on meeting with the directors.
We will contact you to schedule a meeting once you have submitted your registration.
Looking forward to having a great time together at BMC!

I would like to receive news and updates by email

Bat Mitzvah Club Registration

Bat Mitzvah Club Registration Form

Family Information

Bat Mitzvah Girl Information

Payment

Parental Consent