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Jewish Life Center - Chabad of Raleigh - Cong. Sha'arei Israel

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Chanukah Parade and Menorah Lighting 22 Menorah, Movie & Chinese Havdalah, Pizza & PJ party Soup, Salad & Scotch in the Sukkah Lag Baomer Drum Circle & BBQ Purim in Mexico

Sukkot 2021 Lag Ba'omer 5781/2021 CHS 2020/2021 Purim 2021/5781 JWC Glass Fusion Mezuzot JWC Ugly Sweater + Chanukah Gift Exchange

CHS Chanukah 2020 Chanukah Parade and Menorah Lighting

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ב"ה

Bar Mitzvah Application Form

Thank you for your interest in having your son's Bar Mitzvah with us. Please provide us with your information and someone from office will get in touch with you shortly.
The Bar Mitzvah Boy
Full Name*

First Name Last Name

Home Address*

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

Date of Birth* FYI: Time is required for calculating the Hebrew date.

Month Day Year
at Hour Minutes
Hebrew Date of Birth (If known)
Requested Bar Mitzvah Date (If known)

Month Day Year
Hebrew Name (If Known)
Current School*
Grade Entering*
Hebrew Reading Proficiency*

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where?
Father's info
Father's Name*

First Name Last Name
Father's Hebrew Name (If known)
Father is a

CohenLeviIsraelUnkown
Father's E-mail*
Father's Cell*

Area Code Phone Number
Mother's info
Mother's Name*

First Name Last Name
Mother's Hebrew Name (If known)
Mother's E-mail*
Mother's Cell*

Area Code Phone Number
Is the natural mother of the child Jewish?

Jewish by birthConverted
If converted, please specify Rabbinic Authorization: For conversion, please provide us with Certificate of Conversion and Marriage Ketubah. Please note: All Conversions must be accepted by the Orthodox Rabbinical Court, before child can be admitted to Bar Mitzvah Course.
Is the mother's mother Jewish?

Jewish by birthConverted
If converted, please specify Rabbinic Authorization: For conversion, please provide us with Certificate of Conversion and Marriage Ketubah. Please note: All Conversions must be accepted by the Orthodox Rabbinical Court, before child can be admitted to Bar Mitzvah Course.
E-Sign
Parent's Signature please type
Date Signed

Month Day Year
I would like to receive news and updates by email
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Jewish Life Center - Chabad of Raleigh - Cong. Sha'arei Israel

7400 Falls of Neuse Road Raleigh, NC 27615

919-847-8986

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