BMC Registration

Child's Name*
First Name Last Name
Child's Hebrew Name*
Birth Date*

Month Day Year
Parents
Marital Status*
Is the natural mother of the child Born Jewish?*
Has there been any conversion in the family?*
Was the conversion by an Orthodox Beth Din?*
Please contact us to discuss your circumstance before continuing this enrollment process.
Please contact us to discuss your circumstance before continuing this enrollment process.
If yes, please specify Rabbi and Congregation* Before registering, please ensure that your conversion is recognized by The Rabbinical Council of America
Parent 1
Full Name*
First Name Last Name
E-mail*
Phone Number*
Hebrew Name*
Gender*
Occupation*

Address*

Parent 2
Full Name*
First Name Last Name
E-mail*
Phone Number*
Hebrew Name*
Gender*
Occupation*
Any additional notable information about the family
Primary Correspondence should be with*
Preferred method of communication*
Emergency Contact
Full Name*
First Name Last Name
Phone Number*
Relationship To Child*
Does your child take any medications or have any allergies or other medical conditions we should be aware of?* * If yes, please describe. if no, please write no
I hereby give permission for my child(ren) to attend all field trips and outings*

Yes
I hereby give permission for my child(ren) to be photographed during BMC activities, and for the photographs to be published on BMC website and media.*

Yes
Payment
Pay in Full*

$375
If you’re in need of a scholarship, simply select "Other" in the payment section below. A member of our team will follow up with more information.
Help Sponsor A Girl In Full Or Half

$375$180
Total

$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

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Parents