Loading
Parent details
What is your name?
*
First name
Last name
What is your address?
*
Address line 1
Address line 2
City/Suburb
State/Territory
Postcode
What is your email address?
*
What is your phone number?
*
What is your relationship to the bnei mitzvah student?
Where did you hear about learning with Rabbi Shneur?
Word of Mouth
Social Media
Neshama Website
Rabbi Without Borders Website
Please add any other parent/s contact details
What is their name?
First name
Last name
What is their address (if different)
Address line 1
Address line 2
City/Suburb
State/Territory
Postcode
What is their email address?
What is their phone number?
What is their relationship to the bnei mitzvah student?
+ Add another parent/guardian
- Remove
Student Details
Please complete for each student participating in the program.
What is the student's name?
*
First name
Last name
What is their date of birth?
*
Where do they go to school?
*
What year/grade are they in at school in 2025?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
Do you consent us communicating with your child via their own email? This will be useful to share resources with them from the program.
Yes
No
If yes, please provide their email address here:
Bnei mitzvah details
If your child will be having their simchah with Shneur, has a date already been confirmed?
Yes
No, please be in touch about confirming a date
No, we are having our simchah elsewhere
Unsure
If your child is celebrating thier simchah elsewhere, please list where it will take place, and when it will take place.
About Your Child
What is your child's experience with Hebrew?
Does the student have any allergies (food or other) or take any medications that we should be aware of?
Does the student have any learning needs/styles that we should know to help us support your child's learning?
Is there anything else that we should know about your child?
Do you consent to images taken during programming being used on social media and promotional purposes?
Yes
No
Enrollment Fees
$396.00
$396.00
+ Add another child
- Remove
Payment Details
Payment method
Secure Visa/MC credit card payment via stripe.
Direct transfer
Make deposit to account
If you would prefer to make your payment via electronic funds transfer (EFT) please complete this form and then make your payment to:
Kehillat Neshama BSB #: 633 000 ACC #: 223683046
Pay processing fee
$
Total amount
$
Please check the highlighted fields
✔
✘