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 Name Last 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.

Month Day Year

at Hour Minutes

Hebrew Date of Birth (If known)

Requested Bar Mitzvah Date (If known)

Month Day Year

Hebrew Name (If Known)

Current School*

Grade Entering*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Where?

Father's Name*

First Name Last Name

Father's Hebrew Name (If known)

Father is a

CohenLeviIsraelUnkown

Father's E-mail*

Father's Cell*

Area Code Phone Number

Mother's Name*

First Name Last Name

Mother's Hebrew Name (If known)

Mother's E-mail*

Mother's Cell*

Area Code Phone 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 Signature please type

Date Signed

Month Day Year

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The Bar Mitzvah Boy

Father's info

Mother's info

E-Sign