Chabad of Tribeca BAR/BAT MITZVAH CLUB REGISTRATION FIRST NAME, LAST NAME DATE OF BIRTH ADDRESS CITY, STATE, ZIP HOME PHONE PARENT 1 Cell Phone E-mail PARENT 2 Cell Phone E-mail S TUDENT I NFORMATION : Grade, School Year 2015 -16: Email: Cell Number: Best Method of Contact: Email Phone Is there anything that you would like us to know about your child? P LEASE LIST T WO EMERGENCY CONTACTS : Name, Phone, Relationship Name, Phone, Relationship ENROLLMENT FEES: 2015/16: October - June $380.00 or $340 because I referred a new friend! Name of Friend: Phone number: Please note that prices include all session supplies, activities & dinner. Please charge my credit card MC Visa Discover Credit Card Number: Expiration: CVV Code Total amount due: Card Billing address & zip code: This page uses 128 bit SSL encryption to keep your data secure.
