Bar Mitzvah Lessons

Full Name*

First NameLast Name

Hebrew Name*

First NameLast Name

2nd child Full Name

First NameLast Name

2nd Child Hebrew Name

First NameLast Name

Birth Date*

MonthDayYear

School*

Previous Jewish Education

Address*

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

Father's Name*

First NameLast Name

Father's Cell*

Area CodePhone Number

Father's E-mail

Mother's Name*

First NameLast Name

Mother's Hebrew Name

Mother's E-mail

Mother Jewish by:*

BirthConversion

Mother's Cell*

Area CodePhone Number

Is the grandmother on the Mother's side Jewish ?*

Yes, By BirthYes, By ConversionNo

Are there any conversions in the family?*

NoYes

Conversion details (if applicable)

Is the Child a:*

KohenLeviYisroel

Does the child know how to read basic Hebrew?*

YesNo

Does your child own a pair of Teffilin?*

YesNo, I would like the Rabbi's help in purchasing a pairNo, I will purchase a pair on my own

Does the child have any learning challenges with general studies? if yes, please share any relevant information.

Bar Mitzvah Lessons are $2,250.00 Which includes approximately 30 lessons & all recordings & web lessons.

Additional notes or questions:

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Bar Mitzvah Lessons

Student Information

Parents Information

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