Register

Congratulations on your Bat Mitzvah!

Personal Information

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip Code: *

Country: *

Phone Number: *

Additional Phone Number:

Email Address: *

Date of Birth: *

Parent Information

Mother's First Name: *

Mother's Cell: *

Mother's Email: *

Father's First Name:

Father's Cell:

Father's Email:

School Information

School Currently Attending: *

Grade: *

Bat Mitzvah Date

Dedication Opportunities

Sponsor a child for The Center Summer Camp

$8,000

Sponsor a child for The Center Disney Trip

$5,000

Sponsor a show for the children at The Center

$2,000

Sponsor a child at a Center Shabbaton

$1,000

Get to Know The center

How would you like to get to know the children at the Center?

Visit the Center Sunday Program with my family

Invite children from The Center to my school for an activity

Other

Only enter this field if you were told to do so by a staff member.