Bar-Bat Mitzvah Application Form

Address*

Best Contact Number*

Area Code Phone Number
E-mail*
Father's Name

First Name Last Name
Father's Hebrew Name
Mother's Name

First Name Last Name
Mother's Hebrew Name
Is the mother of the child Jewish?*
Is the mother's mother Jewish?*
Is the child a Kohen, Levi or Israelite?
Preferred Bar/Bat Mitzvah Date

Month Day Year
Bar/Bat Mitzvah Preparation $80 per month

$
Have there been any conversions or adoptions in the family history?
If yes, please provide all the necessary information and documentation.

Please note: All conversions must be made through a registered Beth Din that is certified by the Rabbinate of Israel
Please initial as your authorization*
Plese fill in the date of authorization*

Month Day Year
Hebrew Reading Tutoring $60 per class

$
I would like to make an ADDITIONAL donation:

$
Total

$0.00

Payment

Credit Card Check or Cash

Postal / Zip Code

Country

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Bar/Bat Mitzvah Application Form