Bat Mitzvah Form Jan 22

Parent

First Name *

Last Name *

Email *

Phone Number *

Street Address *

City *

Postal Code *

Country *

State/Province

Daughter

First Name *

Last Name *

Phone Number

Birth Date *

Month

Day

Year

Is your Birth Date Before Sunset? *

Yes

Which date will you be celebrating your Bat Mitzvah on?

Month

Day

Year

Please name the school you will be attending for Year 7 *

Please list any allergies

Which shul are you most affiliated with? *

Please specify the shul *

Does your child need any assistance in the room setting?

Yes

Please describe what their needs are so that we can accommodate your child:

Suggested Donation Amount * £

Discount Code

Discount Amount £

Gender *

Current Date

Month

Day

Year

No Photos Checkbox

I do NOT allow for photos to be taken of me or my child

Gift Aid Declaration

UK Tax Payer? *

Yes, and for donations made in the past 4 years

Yes, today and in the future