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Education & Services Kids Bar & Bat Mitzvah

Bar & Bat Mitzvah Registration

Prior to registration we require an initial meeting to discuss what type of ceremony is best for you and your child.

To setup an initial meeting contact us at
(407) 644-2500 Ext.0

For Guidelines on Bar or Bat Mitvzah information click here .
Student Profile
Full Name*

First Name Last Name
Hebrew Name*
Date of Bar/Bat Mitzvah Requested*

Month Day Year
Date of Birth*

Month Day Year
Current School*
Grade Entering*
Hebrew Reading Proficiency*

None Somewhat Well
Previous Jewish Education*

Yes No
Where?
Parent's Information
Father's Full Name*

First Name Last Name
Father's Hebrew Name*
Father's Phone Number*

Area Code Phone Number
Father's E-mail*
Mother's Full Name*

First Name Last Name
Mother's Hebrew Name*
Mothers Phone Number*

Area Code Phone Number
Mother's E-mail*
Are both the natural father and mother of the child Jewish?*

Yes No
If no, please explain*
Are there any conversions in the family?*

Yes No
If yes, please explain*

Address*

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

Other Comments & Details
Payment

Tutoring Lessons: $1,000 for all one-on-one classes (includes 12 Lessons to prepare). Any additional requested classes will cost $100.
Payment Options*
Total

$0.00

Payment

Credit Card

Credit Card Type
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

Should be Empty:

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