Please fill out the student information sheet and deliver it to:

L'ecole Benlolo Bar/Bat Mitzvah School

 

Child Surname : _____________________________________________

Child First Name: _________________________________________

Grade: ______

Address: ___________________________________________

City: ____________________________________________

Province: ___________________________________________

Postal Code: ___________________________________

Parent Surname: ________________________________________

Parent First Name : ____________________________________________________

Home Phone: __________________________________________________

Father work and cell number: (w) ____________________________ (cell)__________________

Mother work and cell number: (w) ___________________________ (cell) __________________

Email address: ______________________________________________