Bar Mitzvah Lessons

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Parent's Information
Father's Name*

First Name Last Name
Father's Cell*

Area Code Phone Number
Father's E-mail*
Marital Status*

MarriedSeparatedDivorced
Mother's Name*

First Name Last Name
Mother's Hebrew Name*
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Are there any conversion's or adoption's in the family?*

YesNo
If yes, please provide details
Does your child know how to read basic Hebrew?*

YesNo
Does your child own a pair of Teffilin?*

YesNo, I would like the Rabbi's help in purchasing a pairNo, I will purchase a pair on my own
Does the child have any learning challenges with general studies? if yes, please share any relevant information.
Fees

$60/Lesson

Your card will be charged at the beginning of every month for that month's lessons.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

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Country

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