Bar Mitzvah Registration

Full English Name*

Hebrew Name

Birth Date*

Month Day Year

Mother's Full English Name*

Mother's Hebrew Name

Address*

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

E-mail*

Phone Number*

Mother Jewish?*

Yes, by birthNoYes, by conversion

If there was a conversion, please put down name and contact of Rabbi

Mother's parents Jewish by birth?*

Is Mother or a parent adopted?*

YesNo

If yes, please detail here

Father's Full English Name*

Father's Hebrew Name

Address*

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

E-mail*

Phone Number*

Father Jewish?*

Yes, by birthNoYes, by conversion

If there was a conversion, please put down name and contact of Rabbi

Father's parents Jewish by birth?*

I give permission for my child to be photographed and/or recorded during Bar Mitzvah lessons and for these photos and videos to be used by Chabad of Central Marin for promotional purposes, including on websites, social media, and other promotional materials.

Parent/Guardian Signature

Complete Bar Mitzvah Program - 18 Lessons ($1,530)

A unique 18-lesson journey that goes beyond preparing for the ceremony, combining Torah reading, prayers, and Tefillin with an engaging exploration of Jewish identity, heritage, values, and the deeper meaning of becoming Bar Mitzvah.

Ceremonial Preparation – 10 Lessons ($850)

Focused preparation for the Bar Mitzvah ceremony only, including Torah blessings, essential prayers, and the student's assigned Torah reading.

I would like to sign up for:*

Complete Bar Mitzvah Program - $1,530Ceremonial Preparation -$850

Thank you for registering! We will review your application and send you a link to complete payment shortly.

I would like to receive news and updates by email

Bar Mitzvah Boy

Mother's Information

Father's Information

Photo and Video Release