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Youth Bar/Bat Mitzvah

Bar/Bat Mitzvah Application Form

Thank you for your interest in having your child's Bar/Bat Mitzvah with us. Please provide us with your information and someone from office will get in touch with you shortly.
The Bar/Bat Mitzvah
Parent/Guardian Full Name*
First Name Last Name
Parent/Guardian E-mail*
Child Full Name*
First Name Last Name

Home Address*

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

Date of Birth* FYI: Time is required for calculating the Hebrew date.

Month Day Year
at Hour Minutes
Preferred Bar/Bat Mitzvah Date:

Month Day Year
Hebrew Name (If Known)
Is the Child a:

KohenLeviIsraelite
Current School*
Grade*
Hebrew Reading Proficiency*

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where?
Father's info
Father's Name*
First Name Last Name
Father's Hebrew Name (If known)
Father is a

CohenLeviIsraelUnkown
Father's E-mail*
Father's Cell*

Area Code Phone Number
Mother's info
Mother's Name*
First Name Last Name
Mother's Hebrew Name (If known)
Mother's E-mail*
Mother's Cell*

Area Code Phone Number
Is the natural mother of the child Jewish?

Jewish by birthConverted
If converted, please specify Rabbinic Authorization: For conversion, please provide us with Certificate of Conversion and Marriage Ketubah. Please note: All Conversions must be accepted by the Orthodox Rabbinical Court, before child can be admitted to Hebrew School.
Is the mother's mother Jewish?

Jewish by birthConverted
If converted, please specify Rabbinic Authorization: For conversion, please provide us with Certificate of Conversion and Marriage Ketubah. Please note: All Conversions must be accepted by the Orthodox Rabbinical Court, before child can be admitted to Hebrew School.
Have there been any conversions or adoptions in the family history?

YesNo
If yes, please include all information and documentation.
E-Sign
I hereby agree that the food/beverages served at the venue of the service officiated by Chabad will be catered in accordance with the Kosher standards of Chabad of OlneyFor Bar Mitzvah: I realize that a Kosher pair of Tefillin and Tallit (total about $500), to the satisfaction of the Rabbi, will be required at least three months before the boy’s 13th Birthday.I hereby agree to have my family participate in services etc. as spelled out in the guidelines.
Parent's Signature please type
Date Signed

Month Day Year
Payment & Fees
Registration Fee $25 • Bar/Bat Mitzvah Preparation Fee $900 • Bar/Bat Mitzvah Service Fee $360
Payment Options:*

The full amount now - $1285 (Registration, Preparation and Service Fee)The registration fee now ($25). The preparation fee will be paid in 4 monthly installments of $225 each and the $360 Service fee will be charged 2 weeks prior to Service
Total

$0.00

Payment

Credit Card Paypal Check

Postal / Zip Code

Country

Should be Empty:

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