Bat Mitzvah Club Application Form

Child's Full Name*

First Name Last Name

Child's Jewish Name

Child's Date of Birth*

Month Day Year

Time of Birth* In Judaism the day begins at nightfall. Time of Birth helps determine the exact date of the Jewish birthday.

Hour Minutes

School Attending*

Grade*

Child's email (if any)

Child's phone number (if any)

Area Code Phone Number

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

Please describe*

Describe all allergies (if any)

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Ready

Home Address*

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

Past membership in a synagogue*

YesNo

Which synagogue(s)?

Is the father Jewish*

YesNo

Is the mother Jewish*

YesNo

Were there any conversions and/or adoptions in the family?*

YesNo

Please explain

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Ready

Father's Full Name*

First Name Last Name

Father's Jewish Name

Check all of the following that apply*

Father's E-mail*

Father's Cell Phone

Area Code Phone Number

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

Please list three people who know you*

Grandfather’s (father’s father) Name*

First Name Last Name

Grandfather’s (father’s father) Jewish Name

Is the Grandfather (father's father) any of the following?*

Grandmother’s (father’s mother) Name*

First Name Last Name

Grandmother’s (father’s mother) Jewish Name

Is the Grandmother (father's mother) any of the following?*

Mother's Full Name*

First Name Last Name

Mother's Jewish Name

Check all of the following that apply*

Mother's Email*

Mother's Cell Phone Number

Area Code Phone Number

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

Please list three people who know you*

Grandfather’s (mother’s father) Name*

First Name Last Name

Grandfather’s (mother’s father) Jewish Name

Is the Grandfather (mother's father) any of the following?*

Grandmother’s (mother’s mother) Name*

First Name Last Name

Grandmother’s (mothers mother) Jewish Name

Is the Grandmother (mother's mother) any of the following?*

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Ready

If you are planning to make a party, where will it be held

ChabadOtherUndecided

Kosher Event

YesNo

If you are planning to sponsor an event, please specify

KiddushAdult Education Class

Planned Date of Bat Mitzvah

Month Day Year

Please describe all plans of the Bat-Mitzvah celebration*

Please describe your specific requests (if any)

Amount

$685

Payment plan Please post-date payments for the end of Nov, Dec, Jan, Feb

Pay in full4 post-dated payments

Payment

⚠ You have not yet connected a credit card processor.

Credit Card Cheque, Cash or E-Transfer

Postal / Zip Code

Country

Total

$0.00

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, email as many Jewish documents as possible. (i.e. Ketuba, photos of headstones of grandparents, photos etc).

Child's Information

______________________________________________________________________________________________________________

General Information

______________________________________________________________________________________________________________

Fathers Information

____________________________________________________________________________________________________________________________

Mothers Information

______________________________________________________________________________________________________________

Celebration Details

_________________________________________________________________________________________________

Financial Commitment

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