Bar Mitzvah Registration

Parent Name*

First Name Last Name

Address*

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

Child Information

Full Name*

Full Name Last Name

Hebrew Name*

First Name Second Name

E-mail* Child's Email

Cell* Child's Cell Phone

Area Code Phone Number

Date of Birth*

Month Day Year

Time of Birth Required to calculate Hebrew date

Hour Minutes

Child* Please Choose One

Biological Mother* Please Choose One

Biological Maternal Grandmother* Please Choose One

Father* Please Choose One

Father is*

KohenLeviYisraelNot Sure

Please note if child has any learning disabilities or difficulties*

Parent Information

Mother

Name*

First Name Last Name

Cell*

E-mail*

Father

Name*

First Name Last Name

Cell*

E-mail*

Service

Desired Month* First Choice

Month Day Year

Desired Month* Second Choice

Month Day Year

Estimated # of Guests in Attendance*

Parental Consent

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 twice 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 make a minimum donation of $1,600 to Chabad of NWBC for the Bar Mitzvah. This includes meetings with parents, rehearsal, use of facility for service (when applicable), and conducting of the service by Rabbi or Mimi Kaplan as arranged.I agree to purchase a new set of Kosher Tefillin for my son to be procured by Rabbi Kaplan from a reputable STA”M distributor (approx. cost of $750). Includes a velvet Tefillin bag with personalized embroidery. This will be paid separately or charged to the card below two months prior to the Bar Mitzvah Service.If the Bar Mitzvah will be part of regularly scheduled Shabbat or Holiday services in the Synagogue (i.e. not a private service), I agree to sponsor and participate in the Kiddush luncheon following services. The cost of a standard, Chabad catered, Bar Mitzvah Kiddush for the weekly congregation NOT including guests is $1250. The Kiddush cost increases according to the number of guests and waiters required (costs are outlined on chabadplace.org/kiddush). If you would like to use an outside kosher caterer, you must obtain prior approval in writing and a $400 coordination fee will be assessed. If the Bar Mitzvah is not part of regularly scheduled Shabbat or Holiday service, a Kiddush is not required. At a private service 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 (Tefilln, Kiddush, etc.) at least two weeks prior to the celebration.

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Donation This is in ADDITION to the required fees listed above

Payment Details

Total

$0.00

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

Payment Plan*

I will pay $3,400 at this time with the credit card below.I agree to pay $3,400 divided in four payments starting now and concluding one month prior to the Bar Mitzvah service, to be charged to the credit card below.

Payment* Card will be processed manually based on your selection above

Credit Card

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

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