BAR MITZVAH MENTORING & LEARNING EXPERIENCE

REGISTRATION FORM 2025-26

83 GREEN LANE, THORNHILL, ON L3T 6K6 905-886-0420 x221
[email protected]


PARENTS ORIENTATION: September 17, 2025

FIRST DAY: October 4, 2025


PLEASE NOTE: Each child must have their own registration.

Child Information

First Name
 
  

Hebrew Name:
Middle:    Last Name

Birthdate:
(MM/DD/YYYY)

  

Home Phone:
Address   City, Province, Postal
Name of Public School child is attending:   Grade starting in September
Parents are:

Married
Divorced
Separated
Other

   Child lives with: (both parents/mother/ father/other)

Are there any allergies or medical conditions we should be aware of? If yes, please explain:
Mother's Information

First Name

  

Hebrew Name

Last Name
 
  

Email
Occupation   Home Phone
Work Phone   Cell Phone
 
Address (if different from above)   City, Province, Postal
Father's Information
First Name   Hebrew Name
Last Name   Email
Occupation   Home Phone
Work Phone   Cell Phone
 
Address (if different from above)   City, Province, Postal
Affiliation

Synagogue your family is affiliated with:

   Are you a member? Yes No

Is the natural mother of the child Jewish:

 Yes No    

If no, please explain:
Were there any conversions/adoptions in your family: Yes No      

If yes, please explain:

PLEASE NOTE: All conversions must be in accordance with Orthodox Halachic standards.
Tuition Information

MEMBERS DISCOUNT:
$50.00 discount per family for members of Chabad Lubavitch of Markham

 

2025-26 Tuition

Only $495 per child
All tuition fees must be paid before January 1, 2026

Discounts: (click only if applies):

CLOM Members subtract $50.00 off of total.

Payment Information
Date of Payment   Card Number
Name on the Card   Exp Date
Total Amount   Security Code