Printed fromChabadTMR.com

ב"ה

Youth Programs Bar & Bat Mitzvah Club

Bar Mitzvah Club Registration

Bar Mitzvah Boy's Name*
First Name Last Name
Bar Mitzvah Boy's Jewish Name
Bar Mitzvah Boy's Birth Date*

Month Day Year
School He Attends*
Grade Starting Fall 2026*
Torah Reading Instruction*

SepharadAshkenaz
Mother's Name*
First Name Last Name
Mother's Jewish Name*
Mother's E-mail*
Mother's Phone Number*

Area Code Phone Number
Father's Name*
First Name Last Name
Father's Jewish Name*
Father's E-mail*
Father's Phone Number*

Area Code Phone Number

Address*

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

Marital Status*
Is there a Conversion in the family?*
Rabbi Who Performed the Conversion:

Payment $400*

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

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.