Girl's Name   Grade  
School   Parent's Names  
Email   Home Phone  
Mother's Cell   Father's Cell  
Hobbies   What I love about being Jewish  
I am registering for  Bat Mitzvah Club
$18 a session or $100 year
 Yaldah Club
$18 a month or $120 a year
   CTeen Leadership Club    
Please note that there is an additonal $36 registration fee to be a part of the Youth Clubs
Credit Card Type   Amount  
Card Number   Exp Date.  
First Name   Last Name  
Billing Address   City  
State   Zip