Bar/Bat Mitzvah Registration

Family Name*
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
E-mail*
Date of Bar/Bat Mitzvah*

Month Day Year
Birth Date*

Month Day Year
Type of Service*
Is the natural born mother of the child Jewish?

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

Yes No
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:

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