Bar/Bat Mitzvah Registration form

Mazal tov on your upcoming Bar/ Bat Mitzvah!

Please fill out this registration form below.

1. The Bar/Bat Mitzvah Boy/Girl

Name*

First NameLast Name

Hebrew name

Birth Date*

MonthDayYear

2. The Parents:

Fathers Name*

First NameLast Name

Hebrew name

Are both of Father's parents Jewish?*

Occupation

Mothers Name*

First NameLast Name

Hebrew name

Are both of Mother's parents Jewish?*

Occupation

Parents E-mail*

Phone Number*

Area CodePhone Number

Address*

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

3. Other:

Any conversions in the family?**

*Please note that Chabad International policy only allows Bar/Bat Mitzvah ceremonies and classes for a child who's mother was born Jewish or went through an orthodox conversion.

Any adoptions in the family?*

4. Bar/Bat Mitzvah Celebration:

Date of Planned Celebration

MonthDayYear

Notes:

Bar/Bat Mitzvah Registration form

Mazal Tov!

Mommy and Me

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Hebrew School

Friendship Circle

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