Bar Mitzvah Lessons

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Parents Information
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's E-mail
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's E-mail
Mother Jewish by:*

BirthConversion
Mother's Cell*

Area Code Phone 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.
Payment Options*

Payment in Full $2250Divide by 10 monthly payments of $225
Total

$0.00

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We accept Visa, MasterCard, American Express, Discover
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Expiration Month	Expiration Year

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