Child's Information 

English Name

Hebrew Name 
Date of Birth    Morning  Evening
Jewish Birthdate (if Known)  Calculate
Entering Grade
Name of School


Schedule of fees:


$250 (Includes all sessions, supplies and snacks.)


Terms of Payment:


I will send a check (Please send this completed form to: The Bat Mitzvah Club C/O Lubavitch of NC 6619 Sardis Rd. Charlotte, NC 28270).
Please charge my credit card: Click Here to make Payment online 



In the event of an emergency, Lubavitch of NC has my permission to arrange for any necessary first aid or care by a licensed physician for my child while he/she is attending the program.

Signature of parent or legal guardian.