Bar Mitzvah Program Registration Form Child First Name* Child Middle Name Child Last Name* Parent First Name* Parent Middle Name Parent Last Name* Parent Contact Number* Parent Email PAYMENT INFORMATION: Standard price $34 per lesson, charged to your nominated credit card at the beginning of each term. Should you be experiencing financial difficulties we don’t want that to hold you back so please let us know (Reuvi 0425-809-642) and we can work something out. Name on Credit Card* Credit Card Number* Expiry* January February March April May June July August September October November December 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 CVV* E- signature and date Sign on the line with your mouse or finger Reset Signature Submit
