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Bar & Bat Mitzvah Registration

Bar & Bat Mitzvah Registration

 

Registration Form for Bar/Bat Mitzvah   

Student Profile
 
First Name
Last Name
Hebrew Name
Date of Bar/Bat Mitzvah Requested          
Date of Birth          
Type of Service

Current School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?

 

Parents Information
 
Father's Name
Father's Hebrew Name
Phone
Email
Mother's Name
Mother's Hebrew 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

 

Payment

Tutoring Lessons - $500 for all one-on-one classes

 
Payment Options

Amount
Card Type
Card Number
Exp. Date   
First Name on Card
Last Name on Card
Billing Address
City
State
Zip
Comments

  

 

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