Bar M. Registration

Parent Name*

First Name Last Name

Address*

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

Child's Full Name*

First Name Last Name

Child's E-mail*

Child's Cell Phone*

Area Code Phone Number

Hebrew Name*

First Name Second Name

Birth Date*

Month Day Year

Child* Please Choose One

Child's Biological Mother* Please Choose One

Child's Maternal Biological Grandmother* Please Choose One

Child's Father* Please Choose One

Mother*

First Name Last Name

Mother's Cell Phone*

Mother's E-mail*

Father*

First Name Last Name

Father's Cell Phone*

Father's E-mail*

Desired Service Month* First Choice

Month Day Year

Desired Service Month* Second Choice

Month Day Year

Estimated # of Guests in Attendance at Service*

Please note if child has any learning disabilities or difficulties*

Consent*

I understand that it is my responsibility to oversee my child’s progress, ensure that they thoroughly review the material learned 5 days each week, and to personally study with them if necessary in order to successfully meet the goals of Bar Mitzvah preparation.I agree to attend Shabbat morning services at least once a month for the entire year preceding the Bar Mitzvah celebration.I agree to make payment of $1,800 to Chabad of NWBC for weekly 30 minute Bar Mitzvah lessons according to the schedule of Bar Mitzvah lessons.I agree to a make a minimum donation of $1,240 to Chabad of NWBC for the Bar Mitzvah. This includes meetings with parents, rehearsal, use of facility for service if applicable and conducting of the service by Rabbi or Mimi Kaplan as arranged.I agree to purchase a new set of Kosher Teffilin for my son to be procured by Rabbi Kaplan from a reputable STA”M distributor (approx. cost of $650) to include a velvet bag with generic and personalized embroidery. This will either be paid separately or charged to the card below two months prior to the Bar Mitzvah ServiceIf the BM will be part of regularly scheduled Shabbat or Holiday services in the Synagogue, I agree to sponsor and participate in the Kiddush luncheon following services (If the Bar Mitzvah is a private service, this is not relevant but please check the box indicating that you have read this.) The cost of a standard, Chabad catered, Bar Mitzvah Kiddush for the regular congregation NOT including guests is $1000. The Kiddush cost increases according to the number of guests and waiters are required as explained on the kiddush page at www.chabadplace.org/kiddush. If you would like to use an outside kosher caterer, it must be approved in writing beforehand and a $400 coordination fee will be assessed. If the service is not part of regularly scheduled services a Kiddush is not required and if you choose, we can provide coffee, cake and fruit for a charge of $8 per person and $300 for set-up, linen and cleaning.I agree to make all additional required payments outlined in this section (Teffiln, Kiddush etc.) at least two weeks prior to the celebration.

Payment* Your card will be manually processed based on your selection here.

I will pay $3,040 at this time with the credit card below.I agree to pay $3,040 divided in four payments starting now and concluding one month prior to the Bar Mitzvah service, to be charged to the credit card below.

Additional Donation This is in ADDITION to the required fees listed above

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

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