Bar Mitzvah Program Registration & Payment Form

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*

CVV*

Bar Mitzvah Program Registration & Payment Form

Bar Mitzvah Program Registration Form

E- signature and date

Sign on the line with your mouse or finger

Bar Mitzvah Program Registration Form

E- signature and date

Sign on the line with your mouse or finger Reset Signature

Sign on the line with your mouse or finger