Bat Mitzvah Program Booking & Payment Form

Child First Name*

Child Middle Name

Child Last Name*

Parent First Name*

Parent Middle Name

Parent Last Name*

Parent Contact Number*

Parent Email

Please enter the names of 2 friends your daughter would like to be placed with.

Friend 1

Friend 2

I have completed a Chabad Malvern Xplor Enrolment form. If you have not please fill one out here

PAYMENT INFORMATION: Standard price $34 per lesson, less childcare deduction
Payment will be processed fortnightly, whether your child attends or not. Months Notice is required for termination of program.

Name on Credit Card*

Credit Card Number*

Expiry*

CVV*

Bat Mitzvah Program Booking & Payment Form

Bat Mitzvah Program Booking & Payment Form

E- signature and date

Sign on the line with your mouse or finger

Bat Mitzvah Program Booking & Payment 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