Bat Mitzvah Application

Address*

Phone Number*

Area Code Phone 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:*

Month Day Year
Bat Mitzvah Location*

I would like my Bat Mitzvah at ChabadI am having an offsite Bat Mitzvah (restrictions apply)
$250 to be paid with completion of this application. Remainder to be paid 30 days prior to Bar Mitzvah Date.
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
*

I would like to hear more about Cteen and Friendship Circle for my child.
Payments:
Bat Mitzvah Preparation Fee with the Rabbi/Rebbetzin*

$50/per lesson (45 min)
One time building usage/service fee:*

$500 to be paid directly to the Chabad House if using the building
I would like to make a donation to the Rabbi officiating the service in the amount of:*

$720$500$360
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

This page uses TLS encryption to keep your data secure.

More in this section

Educate Your Child... Educate a Generation