Bar Mitzvah Registration Form

Child's Information
Child's Full Name*
First Name Last Name
Child's Jewish Name
Child's birthday*

Month Day Year
at Hour Minutes
School Attending*
Past membership in a synagogue*

YesNo
If yes, please list which synagogue(s)
Past attendance at a synagogue*

YesNo
Please describe the knowledge level of your child*
Child's previous Hebrew education (if any)*
Does your child have any learning difficulties with studies?*

YesNo
If yes, please describe*
Child's email (if any)
Parents Information

Home Adress*

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

Home Phone Number*

Area Code Phone Number
Marital status*

MarriedDivorced
Date of marriage

Month Day Year
Place of marriage
Jewish marriage

YesNo
At which congregation
In which location (city, country)
Name of officiating Rabbi
Were there any conversions and/or adoptions in the family?*

YesNo
Please explain
Father's Full Name*
First Name Last Name
Father's Jewish Name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael
Grandfather’s (father’s father) first and last name*
First Name Last Name
Grandfather’s (father’s father) Jewish name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael
Grandmother’s (father’s mother) first and last name*
First Name Last Name
Grandmother’s (father’s mother) Jewish name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael

Father's Work Address

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

Father's Work Phone Number

Area Code Phone Number
Father's cell phone

Area Code Phone Number
Father's E-mail
Please list three people who know you*
Mother's Full Name*
First Name Last Name
Mother's Jewish Name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael
Grandfather’s (Mother’s father) first and last name*
First Name Last Name
Grandfather’s (Mother’s father) Jewish name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael
Grandmother’s (mother’s mother) first and last name*
First Name Last Name
Grandmother’s (Mothers mother) Jewish name
Check all of the following that apply*

Born JewishConvertedKohenLeviYisrael

Mother's Work Address*

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

Mother's Work Phone Number

Area Code Phone Number
Mother's Cell Phone Number

Area Code Phone Number
Mother's Email
Please list three people who know you*
Next section*

Ready
Celebration Details
If you are planning to make a party, where will it be held*

Chabad HouseOther
Kosher Event*

YesNo
If you are planning to sponsor an event, please specify*

KiddushAdult Education ClassDedication a Brick
Planned Date of Bar Mitzvah*

Month Day Year
Please describe all plans of the Bar-Mitzvah celebration*
Please describe your specific requests (if any)
Financial Commitment
Our Policy is Open door/No Membership, however we must get financial support from members of our community, especially those benefiting from our programs. Money will not be in the way of preparing your child for the Bar-Mitzvah, however, we hope you will not abuse this warm open-door policy, and will contribute to the extent of your ability, and help Calgary-Chabad go on with its work.
Suggested contribution for classes and actual Bar-Mitzvah is $1,200.00. Post-dated cheques or credit cards are welcome. Feel free to spread payments for up to two years ($50-100 per month). If you cannot afford this contribution, please feel free to discuss it with Rabbi Matusof.
Please Note: For the use of the kitchen, hall for Kiddush, and Kiddush, there will be a charge. The amount depends on use. This should be discussed with Rabbi Mordechai Groner.
I/We will continue to commit to a pledge in honour of my/our son’s Bar-Mitzvah, and help cover cost in the amount totaling

$1,200
Payment method

Cheque payable to Chabad Lubavitch of Alberta for the above amountPost-dated cheques totaling the amount specified aboveOnline credit card payment

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

In some cases proof of Jewish identity might be required. Rabbi Matusof will be more than happy to guide and help you get what ever is required. Please when possible attach as many Jewish documents as possible. (i.e. Ketuba, photos of headstones of grandparents, photos etc).
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Child's Information

Parents Information

Celebration Details

Financial Commitment