Please fill out this Bar-Bat Mitzvah registration form as best you could. If you have any questions or concerns you'd like to discuss with us, please contact the office at 310.544.5544. CHILD PROFILE Bar or Bat Mitzvah* Bar Mitzvah Bat Mitzvah Child Name* First Name Last Name Hebrew Name If known Date of Birth* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2012 2011 2010 2009 2008 2007 2006 Year Grade Entering* 6th Grade 7th Grade 8th Grade 9th Garde 10th Grade Other Previous Jewish Education* Yes No PARENTS INFORMATION Parents Marital Status Married Divorced Father Name First Name Last Name Jewish by birth* Fathers Jewish Status Yes No Have any of your parents converted to Judaism?* Fathers parents Jewish Status Yes No If Yes, Which Parent? Mother Father Both Father Phone* Area Code Phone Number Father E-mail* Mothers Name* First Name Last Name Jewish by birth* Mothers Jewish Status Yes No Have any of your parents converted to Judaism?* Mothers parents Jewish Status Yes No If Yes, Which Parent? Mother Father Both Mother Phone* Area Code Phone Number Mother E-mail* Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country PAYMENT INFORMATION There is a onetime milestone synagogue fee of $1800.00 for the all life cycles events. The Bar-Bat Mitzvah preparation lesson fees are $45.00 per meet for a forty five minute session. There are aproximatly ten to twelve lessons. No child will be turned away due to a lack of funds! Payment Options I can pay the $1800 and lesson fees I can pay the fees in 10 instalments I will need a partial Scholarship I will need a full scholarship Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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