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Bar Mitzva Discovery Course Form

Bar Mitzva Discovery Course Form


BAR/BAT MITZVA DISCOVERY COURSE
REGISTRATION FORM

1. In which program are you enrolling? (Complete one form per child)

Bat Mitzvah Discovery Course -- $165
Girls, 6th Grade, 8 Tuesdays, 6:30 - 7:45 pm

Bar Mitzva Discovery Course--$165
Boys, 7th Grade, 8 Thursdays (Nov-Jan), 7:00 - 8:15pm

STUDENT INFORMATION
Full Name:
Date of Birth
Hebrew Name
Grade
School Attending
Do the child's parents live together? Yes No

Reads Hebrew?

Describe Jewish education to date:

Is there anything that you can share with us about your child that will help us provide for his/her educational needs?

3. Parents' Information

Mother's Name
Mother's Hebrew Name
Address
City State Zip
Home Phone
Work Phone
Email
Mobile Phone
Mother (of Student) was Born Jewish Converted*
Maternal Grandmother (of Student) was Born Jewish Converted*

Father's Name
Father's Hebrew Name
Address (if different from mother's)
City State Zip
Home Phone
Work Phone
Email
Mobile Phone

Father (of Student) was Born Jewish Converted*
Paternal Grandmother (of Student) was Born Jewish Converted*

Have there been any adoptions or conversions in the family history? Yes No
Explain:

* Please note all conversions must be made through a registered Beth Din that is certified and recognized by the Chief Rabbinate of Israel.

4. Tuition Payment Information

I am registering my child to the following program:

Scholarships are available, please call the office at 408.720.0553 and speak with Rabbi Yisroel Hecht.

I am paying by:
Credit Card
(complete below)
Check (Make payable to Chabad of Sunnvyale and mail to P.O. Box 2118, Sunnyvale 94087-0118

Name
Telephone

Address

City
ST ZIP

Card Type
Card Number
EXP Date CVV

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