Bar-Bat Mitzvah Application Form

Address*

Best Contact Number*

Area Code Phone Number
E-mail*
Mother's Name
First Name Last Name
Mother's Hebrew Name
Is the mother of the child Jewish?*
Father's Name
First Name Last Name
Father's Hebrew Name
Is the father of the child Jewish?*
Is the mother's mother Jewish?*
Are the parents of the child married to each other?*
Is the child a Kohen, Levi or Israelite?
Preferred Bar/Bat Mitzvah Date
Bar Mitzvah club is $850
Additional Private lessons are $45 per lesson as needed.
Have there been any conversions or adoptions in the family history?
If yes, please send/upload certificate of conversion &/or adoption.
Certificate of Conversion/Adoption
Please upload file
Please initial as your authorization*
Plese fill in the date of authorization*

Month Day Year
I would like to make an ADDITIONAL donation:

$
base fees

base fees
Total

$0.00

Payment

Credit Card Paypal ACH, Check, Cash or Zelle

Postal / Zip Code

Country

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Bar/Bat Mitzvah Application Form