Please fill out the form below carefully. When you press submit, this form (secure form) will be sent to our administration office. Student/Parent Information Name First Last Hebrew Name Address Street City Province Postal code Date of Birth Select Month Jan Feb March April May June July August Sept Oct Nov December Select Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select Year 2003 2004 2005 2006 2007 2008 2009 Contact Info Home phone Email Schools School Hebrew School Grade: Student's Mother Mother's Name Hebrew Name Work Phone Cell Student's Father Father's Name Hebrew Name Work Phone Cell Where did you hear about us? Mother Jewish? Select one Yes No Father Jewish? Select one Yes No PAYMENT & FEES: Dates Start date at BMC Date of Bar Mitzvah: Fees $ 1,250 for the year. (1,150 Tuition + one time $100.00 (registration and Book fee). S cholarships Available. I will be paying by: Credit Card Check Etransfer to [email protected] if paying by credit card: Charge in full now Charge the reg. fee now and and split the fee to 5 payments (October 1 to February 1) . Card Type Visa MasterCard American Express Card Number Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2025 2026 2027 2028 2029 2030 2031 2032 IMPORTANT I hereby register my child in JRCC East Thornhill Bar Mitzvah Club: Our club will be meeting Wednesdays throughout the year. See calendar for details. I 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 understand that JRCC East Thornhill does not assume responsibility for any injury, and in case of emergency necessary medical attention may be secured by the JRCC East Thornhill. Parent's signature: This page uses 128 bit SSL encryption to keep your data secure.
