BAR/BAT MITZVAH APPLICATION

CHILD INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Date of Bith*

Month Day Year

Time of Day: To calculate the Jewish Birth date

Hour Minutes

Gender*

Male Female

Is the child a

Kohen Levi Israelite I don't know

Does the child know basic Hebrew?

Does your child own a pair of Tefillin and Tallit (prayer shawl)?

ADDRESS

Address*

PARENT'S INFORMATION

Marital Status

Father's Name*

First Name Last Name

Father's Hebrew Name

Father Cell*

Area Code Phone Number

Father's E-mail*

Is the biological father of the child Jewish?*

Yes No

Mother's Name*

First Name Last Name

Mother's Hebrew Name

Mother Cell*

Area Code Phone Number

Mother's E-mail*

Is the biological mother of the child Jewish?*

Yes No

Is the mother’s mother Jewish?*

Yes No

FAMILY INFORMATION

Have there been any conversions in your family?*

Yes No

If yes, who? And who was the Rabbi?* Please note: Conversion certificates must be approved by the Rabbinate of Israel.

Have there been adoptions in your family?*

Yes No

If yes, please explain?*

CEREMONY

Preferred date of Bar/Bat Mitzvah Ceremony

Month Day Year

*

I certify that all the information given above is true to the best of my knowledge.