Bar Mitzvah Club - Chabad of Port Washington

The Bar Mitzvah Club is a program designed specially for boys who are approaching that very special time in their life. It provides insight and understanding that go beyond Hebrew School basics that will help them better prepare for their memorable celebration period. Members enjoy a combination of learning and fun through regular meetings, special programs and field trips, activities, projects and involvement in the Jewish community.

Bar Mitzvah Club is held on two Sundays of every month from 12:30 pm - 1:30 pm

Bar Mitzvah Club dates for 2010-2011:
COMING SOON..

TO register please fill out your information below:

APPLICANT'S INFORMATION
First Name		Last Name
Hebrew Name		D.O.B.
School		Grade Entering
Cell Phone Number
Which day of the week works for you?	1st Choice 2nd Choice
Previous Jewish Education	Yes No If yes - where?

PARENT INFORMATION
Father's Name	Father's Cell
Mother's Name	Mother's Cell
Address	City, State, Zip	City State Zip
Home Phone	Email
Were there any conversions or adoptions in the family? Yes No
If yes, please explain:

EMERGENCY INFORMATION
Emergency Contact 1			Phone
Emergency Contact 2			Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Bar Mitzvah Club to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Bar Mitzvah Club personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all club activities, join in club trips on and beyond Chabad properties and allow my child to be photographed while participating in Bar Mitzvah Club activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

PAYMENT DETAILS
• Club Cost for the 2010/2011 will be $180, which includes all supplies, materials, trips and Shabbatons.
Name on card	Card Type
Charge Amnt.	Card Number
Exp. Date	CVV Code	3 digits on back of card

For more information please contact Rabbi Weinberg at (516) 767-8672
or email rabbiweinberg@chabadpw.org

Chabad of Port Washington • 80 Shore Road • Port Washington, NY 11050 • 516-767-8672