Bar/Bat Mitzvah Registration form

Mazal Tov!
Mazal tov on your upcoming Bar/ Bat Mitzvah!

Please fill out this registration form below.
1. The Bar/Bat Mitzvah Boy/Girl
Name*

First Name Last Name
Hebrew name
Birth Date*

Month Day Year
2. The Parents:
Fathers Name*

First Name Last Name
Hebrew name
Are both of Father's parents Jewish?*
Occupation
Mothers Name*

First Name Last Name
Hebrew name
Are both of Mother's parents Jewish?*
Occupation
Parents E-mail*
Phone Number*

Area Code Phone Number

Address*

3. Other:
Any conversions in the family?**
Any adoptions in the family?*
Please explain:
*Please note that Chabad International policy only allows Bar/Bat Mitzvah ceremonies and classes for a child who is born Jewish according to Halacha-Orthodox Jewish Law- (matrilineal line) or went through an orthodox conversion.
4. Bar/Bat Mitzvah Celebration:
Date of Planned Celebration

Month Day Year
Notes:
Please be aware that filling out this form is only the first step to register for a Bar/Bat Mitzvah and/or classes. Acceptance to the class and the celebration date is not confirmed until approved and a contract is signed by the administrator and Rabbi.
*

I hereby certify that the information given above is true and correct
Should be Empty:

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Mazal Tov!