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ב"ה

Hebrew School and Youth

Bar Mitzvah Application

Bar Mitzvah Boy Full Name *
First Name Last Name
BMB Birth Date*

Month Day Year
Time of Day:*
Hour Minutes
BMB Hebrew Name:*

Address*

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

Father's Phone Number*

Area Code Phone Number
Mother's Phone Number*

Area Code Phone Number
Father's E-mail*
Mother's E-mail*
Father's Name: *
Father's Hebrew Name:*
Mother's Name:*
Mother's Hebrew Name:*
Is the natural mother of the child Jewish?*
Is the natural father of the child Jewish?*
Is the maternal grandmother Jewish?*
Is the maternal great-grandmother Jewish?*
Maternal Grandmother's Hebrew Name:*
Is the child a Kohen/Levi or Israelite?*
Maternal Great-Grandmother's Hebrew Name:*
Have there been any conversions or adoptions in the family history?* ** If yes, please upload all information and documentation. ** Please note: All conversions must be made through a registered Beth Din that is certified by the Rabbinate of Israel.

YesNo
Please include all backup information and documentation:*
Please upload any relevant documentation:
Preferred Bar/Bat Mitzvah Date:*

Month Day Year
Does the child know basic Hebrew?*
Does the child have any learning problems with general studies?*
Does your child own a pair of Tefilin?*
*

I certify that all the information given above is true to the best of my knowledge.
Guidelines:
*

I agree that all food and catering associated with this Bar Mitzvah Celebration will be in accordance with Kosher standards.
*

Bar Mitzvahs will be done on or after the child’s Hebrew 13th Birthday
*

I agree to purchase a pair of Tefilin for the Bar Mitzavh boy from Chabad
*

The Bar Mitzvah boy must attend at least 6 Shabbat Services in the months prior to the celebration.
*

I Agree to pay $70 for Bar Mitzvah lesson (45 Minutes)
*

Please note: Bar Mitzvah boy must attend Hebrew School in order to study Hebrew Reading and Jewish Basics. Bar Mitzvah Ceremony fee $360 (Due at time of registration in order to confirm date). (This fee does not include Kiddush sponsorship or $360, facility use fee and $100 cleaning fee). In addition, Bar Mitzvah Lessons, if needed, with the rabbi are $70 per session (45 minutes). Please discuss with the office about the celebration options. (All fees must be paid in advance. For financial assistance, if no other party is being held, speak to our office).
*

Ceremony Fee: $360.00, $180 to be paid upon completion of form, $180 to be paid 30 days prior to BAr MItzvah
Other Payments/Fees: NOT DUE NOW
For boys only: Tefillin Due 3 months prior to the Bar Mitzvah Date

$600 (Basic Kosher Teffilin)$800 (Regular Kosher Teffilin)$1000 (Premium quality kosher Tefillin)
One time building usage/service fee:

$500 to be paid directly to the Chabad
PAYMENT DUE NOW:
Ceremony Fee: $360, $180.00 to be paid with completion of this application. Remainder to be paid 30 days prior to Bar Mitzvah Date.
*

180.00 Ceremony Fee Deposit
I would like to make a donation to the Rabbi officiating the service in the amount of:

$720$500$360$180
Total

$0.00

Payment

Credit Card Paypal

Postal / Zip Code

Country

Should be Empty:

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