Bar Mitzvah Lessons

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Parent's Information
Father's Name*
First NameLast Name
Father's Cell*
Area CodePhone Number
Father's E-mail*
Marital Status*
MarriedSeparatedDivorced
Mother's Name*
First NameLast Name
Mother's Hebrew Name*
Mother's Cell*
Area CodePhone 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

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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