C-Girls Registration

ABOUT

PHOTO GALLERY

REGISTER ONLINE

We are currently accepting application forms for 2020-2021. Please fill out ALL fields of this form.
If you have any questions or concerns you'd like to discuss with us, please contact us.

*Please note that one registration form per applicant is needed.

Full Name*

First NameLast Name

Hebrew Name

Age*

Birth Date*

MonthDayYear

School*

Grade Entering*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

Father's Name

First NameLast Name

Father's Religion

Father's Occupation

Father's Business Name

Father's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's E-mail

Father's cell

Area CodePhone Number

Mother's Name

First NameLast Name

Mother's Religion

Mother's Occupation

Mother's Business Name

Mother's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's E-mail

Mother's Cell

Area CodePhone Number

Marital Status of Parents:*

MarriedSeparatedDivorced

If divorced - how long?

Emergency Contact 1*

First NameLast Name

Relation to Child*

Phone Number*

Area CodePhone Number

Business Phone

Area CodePhone Number

Emergency Contact 2*

First NameLast Name

Relation to Child*

Phone Number*

Area CodePhone Number

Business Phone

Area CodePhone Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

If parents cannot be reached and emergency medical advice is needed, permission is given to the BMC staff to phone my child’s doctor:

Doctor's Name*

First NameLast Name

Doctor's Phone*

Area CodePhone Number

Doctor's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Doctor's Hospital Affiliation*

Permission for Emergency Medical Treatment:*

In case of emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary.

Which program would you like to enroll your daughter in?

Once a week - $800 All InclusiveOnce in two weeks - $500 All Inclusive

Commitment*

I understand that by submitting this form I am committing to pay the above outlined tuition fees.

Name*

First NameLast Name

Initials*

Date*

MonthDayYear

Payment*

Credit Card Cash or Check

Postal / Zip Code

Country

Amount to charge my card today

$500$800

Total

$0.00

Applicant Information

Father's Information

Mother's Information

Emergency Information

Payment Plan

Secure Online Payment