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 PROFILEBar or Bat Mitzvah*Bar MitzvahBat MitzvahChild Name*First NameLast NameHebrew NameIf knownDate of Birth*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2012201120102009200820072006YearGrade Entering*6th Grade7th Grade8th Grade9th Garde10th GradeOtherPrevious Jewish Education*YesNoPARENTS INFORMATIONParents Marital StatusMarriedDivorcedFather NameFirst NameLast NameJewish by birth*Fathers Jewish StatusYesNoHave any of your parents converted to Judaism?*Fathers parents Jewish StatusYesNoIf Yes, Which Parent?MotherFatherBothFather Phone*Area CodePhone NumberFather E-mail*Mothers Name*First NameLast NameJewish by birth*Mothers Jewish StatusYesNoHave any of your parents converted to Judaism?*Mothers parents Jewish StatusYesNoIf Yes, Which Parent?MotherFatherBothMother Phone*Area CodePhone NumberMother E-mail*Address*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryPAYMENT INFORMATIONThere 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 OptionsI can pay the $1800 and lesson feesI can pay the fees in 10 instalmentsI will need a partial ScholarshipI will need a full scholarshipShould be Empty: Submit This page uses TLS encryption to keep your data secure.
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