Registration Form

Child Information

Tell us about your child joining Bat Mitzvah Club.

Child's Full Name *

Child's Hebrew Name *

Birth Date *

Is your child currently part of Chai Hebrew? *

Yes No

Family Background

These questions help us prepare accurately for your child's program.

Parents' Marital Status *

Is the child's natural mother Jewish from birth? *

Yes No

Is there a conversion in the family's history? *

Yes No

Was it an Orthodox conversion?

Yes No

Rabbi & Congregation where the conversion took place

Parent / Guardian 1

This person will be the primary contact on file.

Full Name *

Hebrew Name *

Email *

Phone Number *

Born Jewish? *

Yes No

Gender *

Male Female

Occupation *

Home Address

Street Address *

Street Address Line 2 (optional)

City *

State/Province *

Postal/Zip Code *

Parent / Guardian 2

If applicable — leave blank if not relevant to your family.

Full Name

Hebrew Name

Email

Phone Number

Born Jewish?

Yes No

Gender

Male Female

Occupation

Additional Details

A few last things before we wrap up.

Anything else we should know about your family? (optional)

Preferred Primary Contact *

Preferred Communication *

Emergency Contact

First Name *

Last Name *

Phone Number *

Relationship to Child *

Medical Conditions / Allergies (optional)

Permissions

I give permission for my child to participate in supervised field trips.

I give permission for my child to be photographed for Chabad of Park Slope materials.

Almost Done

Choose how you'd like to handle registration payment. You'll complete secure payment on the next page.

Payment Option *

You can select more than one.

Pay in Full $375 Help sponsor a child $375 Payment Plan – I will speak to Shaina Monthly Additional Donation $50–$1,800

Total *

Submitting this form sends your registration details to Chabad of Park Slope. You'll then be taken to our secure payment page to complete your registration — no payment information is collected on this page.

I confirm the information provided above is accurate to the best of my knowledge.

Bat Mitzvah Club Registration

Child Information

Family Background

Parent / Guardian 1

Parent / Guardian 2

Additional Details

Almost Done

You're registered!