Bar Mitzvah Application

Full Name*
First NameLast Name
Birth Date*
MonthDayYear
Time of Day:*
HourMinutes
Hebrew Name:*

Address*

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

Phone Number*
Area CodePhone Number
Parent's E-mail*
Father's Name:*
Mother's Name:*
Is the natural mother of the child Jewish?*
Is the maternal grandmother Jewish?*
Is the maternal great-grandmother Jewish?*
Father's Hebrew Name:*
Mother's Hebrew Name:*
Maternal Grandmother's Hebrew Name:*
Maternal Great-Grandmother's Hebrew Name:*
Have there been any conversions or adoptions in the family history?*** If yes, please send all information and documentation.
** Please note: All conversions must be made through a registered Beth Din that is certified by the Rabbinate of Israel.
Preferred Bar/Bat Mitzvah Date:*
MonthDayYear
Guidelines:
*
I agree that all food and catering associated with this Bar Mitzvah Celebration will be in accordance with Kosher standards.
*
Bar / Bat Mitzvahs will be done on or after the child’s Hebrew Birthday 12 years old for a girl & 13 years old for a boy
*
My child will stay involved with Cteen Jr. for the following year
*
For boys: My child will continue to attend the Monthly Teffilin club after his Bar Mitzvah
Payments:
Bar/Bat Mitzvah Preparation Fee with the Rabbi:*
$60-70 per lesson (45 min - 1 hour)
For boys only: Tefillin*Due 3 months prior to the Bar Mitzvah Date
$530 (Basic Kosher Teffilin)$700 (Regular Kosher Teffilin)$900 (Premium quality kosher Tefillin)
One time building usage/service fee:*
$500 to be paid directly to the Chabad House
$250 to be paid with completion of this application. Remainder to be paid 30 days prior to Bar Mitzvah Date.
Building Usage Fee*
Pay 250 deposit room feePay total room fee now
I would like to make a donation to the Rabbi officiating the service in the amount of: Will be charged a month prior to the service*
$360.00$500.00$800.00
Total
$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Guidelines:

Payments: