B' Mitzvah Cohort Registration

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Please fill out the form completely. If you are logged in to your KHL account, your information will automatically be filled in on the first section.
Make sure to hit the "submit" button at the end of the form.

5th and 6th GradersB'Mitzvah FeeCurrently registered B'Mitzvah Students

Total:

* Parent 1 Full Name

* Parent 1 Email Address

* Street Address (Primary)

* Zip Code

* Best Phone to Contact

* Parent 2 Full Name

Address for Parent 2 (if different than Parent 1)

Parent 2 Zip Code (if different than Parent 1)

Parent 2 Phone number

* (1) Child's First Name

* (1) Child's Last Name

* (1) Child's Birth date

(1) Child's Hebrew Name

* (1) Child's School

* (1) Child's Grade

Please let us know if your child has any allergies.

Allergies (Child 1)

Is there any information we should know about your child to optimize their experience during this B'Mitzvah Program?

Notes for teachers:

(2) Child's First Name

(2) Child's Last Name

(2) Child's Birth date

(2) Child's Hebrew Name

(2) Child's School

(2) Child's Grade

Please let us know if your child has any allergies.

Allergies (Child 2)

Is there any information we should know about your child to optimize their experience during this B'Mitzvah Program?

Notes for teachers:

* Emergency Contact:

Please provide the name, phone number and relationship to child.

* Photo Permission

Please Select OneYesNo

Permission to use photos of students in KHL publications -

No names will be posted.

Fri, October 18 2024 16 Tishrei 5785