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* Student's Full Hebrew Name

(Includes the Hebrew name/s of parent/s: e.g. Yoseph ben Yaakov or Miryam bat Avram v'Tziporah)

* First Aliyah Date and Time

(Please insert the date that is printed on the Bar/Bat Mitzvah form that was mailed to you)

* A student's Bar/Bat Mitzvah date is only confirmed once the Temple Office receives this form with half of the $1,000 Bar/Bat Mitzvah fee ($500). The Temple is not held responsible for any dates released due to non-payment of the deposit. Payment can be made through this online form or a mailed to Temple Beth Shalom.

Agree

* I uderstand that in order for my child to have a Bar/Bat Mitzvah on this date, my account with the Temple will be kept current, and my child will continue to be enrolled in our Religious School or another Jewish Studies program approved in advance by Rabbi Bar-Lev or Rabbi Herzog.

Agree

* Community and inclusion are central values of our congregation. I understand the Temple policy of inviting our child's entire Religious School grade to all aspects of the Bar/Bat Mitzvah celebration.

Agree

* All Bar/Bat Mitzvah ceremonies take place at 10am on Saturday mornings. In the event of a conflict with the time and the service has to take place later in the day, there will be an additional fee of $500 to open the building and provide proper staffing and security. Any time change must be cleared by the Senior Rabbi.

Agree

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Bar/Bat Mitzvah Date Confirmation Form

Student Information

Parent Information

Additional Information

IMPORTANT:

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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	Undecided at this time

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	Undecided at this time

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Bar/Bat Mitzvah Date Confirmation Form

Student Information

Parent Information

Additional Information

IMPORTANT:

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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