Are you ready to embark on a meaningful journey of tradition and personal growth? Join our Bar/Bat Mitzvah program, where we offer a supportive and enriching environment to prepare for this important milestone. With engaging lessons, personalized guidance, and a vibrant community, we ensure that you and your child feel confident and connected to your heritage. Sign up today and take the first step towards a memorable and inspiring Bar/Bat Mitzvah experience! *For students entering 6th - 7th Grade. Program Fee: $870 - Weekly Sunday Bar/Bat Mitzvah Club, 9.30am - 11.30am For one-on-one Bar/Bat Mitzvah preparations, please reach out to Rabbi Gopin (Phone: 305-573-9995) to discuss fee and schedule. Child Information How many child(ren) are you registering?* up to 3 Your Name* Parent Submitting First Name Last Name Child 1 Full Name* First Name Last Name Hebrew name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* BoyGirl School* Grade entering* Please select6th7th Previous Jewish Education* YesNo Where?* Second Child Child 2 Full Name* First Name Last Name Hebrew Name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* BoyGirl School* Grade entering* Please select6th7th Previous Jewish Education* YesNo Where?* Third Child Child 3 Full Name* First Name Last Name Hebrew Name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender BoyGirl School* Grade Entering* Please select6th7th Previous Jewish Education* YesNo Where?* Please describe your family's Jewish background/education (if applicable). Is the biological mother of the Child(ren) Jewish?* YesNo Did the child(ren), their biological mother, or biological grandmother undergo any conversion process or adoption?* YesNo Please provide details* Indicate names if submitting for multiple children Do/Does your child(ren) have any allergies or special medical considerations?* YesNo Please describe them and indicate special precautions or care needed.* Indicate names if submitting for multiple children Do/Does your child(ren) have an IEP or receive any behavioral or educational support in school? (Sharing this information with us enables us to create a Hebrew School environment in which your child(ren) can thrive)* YesNo Please explain* Indicate names if submitting for multiple children Parents Information Father's Name* First Name Last Name Father's Hebrew Name* Father's Cell* Area Code Phone Number Father's E-mail* Occupation* Mother's Name* First Name Last Name Mother's Hebrew Name Mother's Cell* Area Code Phone Number Mother's E-mail* Mother's Occupation* Best way to send updates:* Cell PhoneEmail I would love to be a part of my child’s Jewish education! Please feel free to contact me if there are any opportunities to get involved. I would like to receive news and updates by email Home Phone* Address* Please indicate your apartment/unit number if applicable. 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Emergency ContactPersons to be contacted in case of an emergency when parents cannot be reached. Please provide two contacts. Contact 1* First Name Last Name Phone Number* Relationship to child* Contact 2* First Name Last Name Phone Number* Relationship to child* PAYMENT Payment Credit Card Zelle/Venmo Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPlease complete the form and make payment to:Zelle: [email protected]Venmo: @MidtownChabadBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.* Please check* I accept. Mother's signature* First Name Last Name Today's date* Month Day Year Father's signature* First Name Last Name Today's date* Month Day Year Submit Clear Form Educate Your Child... Educate a Generation Should be Empty: This page uses TLS encryption to keep your data secure.
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