Bar Mitzvah Application Form

Address

School
Grade
Bar Mitzvah Boy Cell
Bar Mitzvah Boy E-mail
Living With

ParentsMotherFather
Select all that apply

Father is JewishMother is JewishMother's mother is JewishThere were conversions in the family
Who converted?
What was the name of the Rabbi who officiated the conversion?
Parent Information
Father
Full Name
Title First Name Hebrew Name (if known) Last Name
Occupation
Business Name
Cell Number
E-mail
Mother
Full Name
Title First Name Hebrew Name (if known) Last Name
Occupation
Business Name
Cell Number
E-mail
Are parents separated or divorced?

YesNo
Who has legal custody?
Preferred number to use when contacting parents

Mom’s CellDad’s Cell
Tutoring Fee: $50.00 per hour

*Payment options are available. No child will be turned away due to lack of funds.
Signature of Parent/Guardian
Date

Month Day Year
Where did you hear about us?
Bar Mitzvah Boy Questionaire
What subjects do you enjoy studying/learning about most?
What are your hobbies/extracurricular activities? What do you like to do in your spare time?
In one or two sentences, explain what being Jewish means to you?
Have you ever been in a Jewish camp or school? If yes which one(s)?
What Jewish subjects have you studied before (such as Hebrew alphabet, holidays, history, etc.)?
List the Jewish holidays you know about:
List the Jewish customs and mitzvot you know about:
Are there any questions, or topics, about Judaism which interest you and you would like to know more about?
$50

Payment

Credit Card

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

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Student Information