Registration Form for Bar/Bat Mitzvah

Student Profile
 
   
Child's First Name
Child's Last Name
Hebrew Name
Date of Bar/Bat Mitzvah Requested
Date of birth
Type of Service

Hebrew Reading Proficiency None Somewhat Well
   
Parent Information
 
Father's Name
Phone
Email
Mother's Name
Phone
Email
Are both the natural father and mother of the child Jewish? Yes No
If no, please explain
Are there any conversions in the family? Yes No
If yes, please explain
Address
City
State
Zip
Other Comments & Details
Pay Online

Non-Hebrew School students: $3600 -  includes all lessons and the ceremony

Hebrew School students: $1800 - includes all lessons and the ceremony

There is a separate Hall Fee for a catered affair at Chabad:  (Includes set up and clean up. Does not include food )
 
Sponsorships Are Available

Please call me to arrange a payment plan

Please send me a scholarship application form
Payment Options

I would like to sponsor a Bar/Bat Mitzvah for another child for $3600.


I would like to contribute: $18 $50 $100 $500 or other: towards the Bar/Bat Mitzvah of a child.


Please charge my credit card.
Amount $
Card Type
Card Number (if you plan to pay by check, please write "Check" in the box)
Exp. Date
First Name
Last Name
Address
City
State
Zip