Bar Mitzvah Registration

Father's Full Name

First Name Last Name

Father's Hebrew Name

Father's Phone Number

Father's E-mail

Mother's Full Name

First Name Last Name

Mother's Hebrew Name

Mother's Cell Number

Mother's E-mail

Address

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

Is the Father Jewish?

YesNo

Is the Mother Jewish?

YesNo

Marital Status of Parents

MarriedDivorcedSeparated

Any conversions in the family?

YesNo

If yes, please explain:

*Please note that Chabad International policy only allows Bar/Bat Mitzvah ceremonies and classes for a child who is born Jewish according to Halacha-Orthodox Jewish Law- (matrilineal line) or went through an orthodox conversion.

Bar Mitzvah Boy

First Name

Hebrew Name

Birth Date

Month Day Year

Bar Mitzvah date will be reserved only after meeting with the Rabbi.

Bar Mitzvah Date Preference

Month Day Year

I hereby confirm that all the above information is correct.

I would like to receive news and updates by email

Bar Mitzvah Registration Form

Family Information

Bar Mitzvah Boy Information

Signature