Bar/Bat Mitzvah Registration

Family Name*
Full Name*
First NameLast Name
Hebrew Name
First NameLast Name
E-mail*
Date of Bar/Bat Mitzvah*
MonthDayYear
Birth Date*
MonthDayYear
Type of Service*
Is the natural born mother of the child Jewish?
YesNo
If no, please explain
Are there any conversions or adoptions in the family?*
YesNo
If yes, please explain
Please note, as per Chabad International policies, Chabad is authorized to preform life-cycle services for children who's natural born mothers are Jewish either through a Jewish mother or an Orthodox Conversion.
I have read and agree to the guidelines in the Bar Mitzvah Handbook
Other comments and details
Should be Empty:

This page uses TLS encryption to keep your data secure.