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Bat Mitzvah Club

Register

Chabad V.s.L. - Bois Franc
Bat Mitzvah Club
2500 des Nations, #200, V.s.L QC H4R 3J9
Phone: 514.747.1199
Email: bmc@chabadvsl.com
Child's Full Name*
First NameLast Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
Area CodePhone Number
Fax Number
Area CodePhone Number
Child's Date of Birth*
MonthDayYear
Hebrew Birthday (or time of birth)*
School presently attending*
School(s) attended in the past*
Mother's Full Name*
First NameLast Name
Mother's Hebrew Name*
Mother's Work Phone Number*
Area CodePhone Number
Mother's Cell Phone Number*
Area CodePhone Number
Mother's E-mail*
Father's Full Name*
First NameLast Name
Father's Hebrew Name*
Father's Work Phone Number*
Area CodePhone Number
Father's Cell Phone Number*
Area CodePhone Number
Father's E-mail*
Emergency Contact Name
Emergency Contact Name*
First NameLast Name
Relationship*
Emergency Phone Number*
Area CodePhone Number
Medicare #*
Exp*
Please list any allergies or health concerns*
Please list any conversions or adoptions in the family*
My hobbies, talents, or interests*
Should be Empty:

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