Bar Mitzvah Application Form

Thank you for your interest in having your son's Bar Mitzvah with us. Please provide us with your information and someone from office will get in touch with you shortly.

Full Name*

First NameLast 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.

MonthDayYear

at HourMinutes

Hebrew Date of Birth (If known)

Requested Bar Mitzvah Date (If known)

MonthDayYear

Hebrew Name (If Known)

Current School*

Grade Entering*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Where?

Father's Name*

First NameLast Name

Father's Hebrew Name (If known)

Father is a

CohenLeviIsraelUnkown

Father's E-mail*

Father's Cell*

Area CodePhone Number

Mother's Name*

First NameLast Name

Mother's Hebrew Name (If known)

Mother's E-mail*

Mother's Cell*

Area CodePhone 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.

Parent's Signatureplease type

Date Signed

MonthDayYear

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The Bar Mitzvah Boy

Father's info

Mother's info

E-Sign