Club Registration Form

Use this form to register for the Bar Mitzvah or Bat Mitzvah Clubs. Registration fee must be submitted at the time of registration.
Bar/Bat Mitzvah club fee: $650
Upon registration you will receive an email to arrange club payment. Payment plans available.
Please note that Bar/Bat Mitzvah clubs do not include the Bar/Bat Mitzvah ceremony; please reach out privately to arrange.
Your Information
*

Bar Mitzvah ClubBat Mitzvah Club
Full Name*

First Name Last Name
Date of Birth

Month Day Year
DayNight
Hebrew Name

Address

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

Phone Number

Area Code Phone Number
E-mail*
Phone Number*

Area Code Phone Number
Father's Name

First Name Last Name
Mother's Name

First Name Last Name
Father's Hebrew Name
Mother's Hebrew Name
Preferred Bar/Bat Mitzvah Date

Month Day Year
at Hour Minutes
Hebrew Date of Birth
Is the natural mother of the child Jewish?*

YesNo
Is the mother’s mother Jewish by birth?*

YesNo
Have there been any conversions or adoptions in the family history?*

YesNo
If yes, please include all information and documentation. Please note: All conversions must be made through a registered Beth Din that is certified by the Rabbinate of Israel.
Bar Mitzvah:*

I hereby agree that the reception associated with the Bar Mitzvah ceremony will be catered in accordance with the Kosher standards of Chabad.I realize that a Kosher pair of Tefillin, to the satisfaction of the Rabbi, will be required at least three months before the boy’s 13th Birthday.I realize that the administration of Chabad reserves the right to cancel any Bar Mitzvah ceremony if any of these guidelines are being violated.
Bat Mitzvah*

I hereby agree that the reception associated with the Bat Mitzvah ceremony will be catered in accordance with the Kosher standards of Chabad.I realize that the administration of Chabad reserves the right to cancel any Bat Mitzvah ceremony if any of these guidelines are being violated.
Order and Payment Information
Registration fee*

$125
Club fee - $650. Please select how much you would like to pay today.*

$100$350$650
Total

$0.00

Credit Card Paypal Will pay by check

Postal / Zip Code

Country

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