Bar Mitzvah Ceremony Registration Form

Mother's Name:*

First Name Last Name

Mother's Hebrew Name:*

Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Cell Phone Number:*

Mother's E-Mail:*

Mother's Birth Date*

Month Day Year

Father's Name:*

First Name Last Name

Father's Full Hebrew Name:*

Address: if different from the one above

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Cell Phone Number:*

Father's E-Mail:*

Father's Birth Date:*

Month Day Year

Child's Name:*

First Name Last Name

Child's Full Hebrew Name:*

Kohen, Levi, Yisroel?*

Child's E-Mail:

Child's Phone Number:

Child's Birth Date:*

Month Day Year

Time Of Birth:*

Hour Minutes

Prefered Date Of Ceremony:*

Month Day Year

at Hour Minutes

Where will the Bar Mitzvah take place?*

Bar Mitzvah Location if NOT at Chabad at Monterra:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I have read and agreed to all rates and fees as listed on the Bar Mitzvah Guidelines Form. *

I agree to fulfill all fees one month prior to my son's Bar Mitzvah.*

I agree to fulfill all fees today for my son's Bar Mitzvah.*

I would like to receive news and updates from Chabad at Monterra by email. I understand that information I provide to Chabad at Monterra will be used according to its Privacy Policy and I can unsubscribe at any time.

Fees for the Bar Mitzvah Ceremony:
Chabad at Monterra Annual Family Membership: $1,800
Additional Private Lessons: $65/ Each
Registration Fee: $150
Cleaning Fee: $250
Security Fee: $200
Tree Of Life Plaque: $250
Chabad at Monterra Facility Fee: $360
Officiating Fee: $500
Tefillin: $600-$1550
Ceremonies at other locations:
Weekday Officiating Fee: $750
Weekend Officiating Fee: $1,800

Chabad at Monterra Annual Family Membership:* *All annual memberships will be automatically renewed on it's anniversary date*

I Agree For Chabad To Charge The $150 Non-Refundable Registration Fee:*

Cleaning Fee:*

Security Fee:*

Tree Of Life:*

Facility Fee:*

Officiating Fee: *

Tefillin:*

Total:

$0.00

*Please note that your $150 registration fee is non refundable*

Payment Plan:* Please select your preferred payment plan.

One paymentPlease divide total into 5 payments charged on the 1st of each month.

I would like to donate the cost of processing this transaction by adding 3%:

YesNo

Payment:*

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Credit Card Paypal Zelle: [email protected] / Venmo: @Chabadatmonterra.com

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Bar Mitzvah Ceremony Registration Form

Bar Mitzvah Ceremony Registration Form

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