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Bar Mitzvah / Bat Mitzvah Class, Registration

Bar Mitzvah / Bas Mitzvah Class, REGISTRATION
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
School*
Previous Jewish Education*
Grade entering*

Address*

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

Additional notable Information
Parents Information
Father's Name*
First NameLast Name
Father Cell
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother Cell
Area CodePhone Number
Payment
Registration Fee
$150
Total
$0.00
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Payment

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Postal / Zip Code

Country

Should be Empty:

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