Bar Mitzvah Lessons Application

We're so excited to be bringing Bar prep classes to the LES!

This is an initial form to help us get to know your child, your goals, what they're like, and how we can best support them. From here, we'll match your child with a young adult mentor to learn and prepare alongside them in honor of their Bar or Bat Mitzvah.

Whether your child needs help with Hebrew, learning their parsha, building their speech, or simply getting more involved, we'll meet them exactly where they are.

We can't wait to be part of this journey with you and to share in such a joyous occasion.

Mazel Tov 🎉

* If you have any questions or concerns you'd like to discuss with us, please contact us.

Full Name*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

Born before sunset

Child's Hebrew birthday (if you know it — we can help you find it if not)

School Attending*

Previous Jewish Education*

YesNo

If yes, Where

Address*

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

Hebrew Reading Ability*

Are you a *

Parental Marital Status**

Mother*

First Name Last Name

Childs Mother : Background*

Jewish by birthJewish by ConversionNot Jewish

E-mail*

Phone Number*

Home Address*

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

Father*

First Name Last Name

E-mail*

Phone Number*

Father: Background*

Jewish by birthJewish by ConversionNot Jewish

Primary Contact*

MotherFatherBoth

Child Lives With*

Is the natural mother of the child Jewish?*

YesNo

Have there been any conversions or adoptions in the family?* Please include as much information as possible. If not, write "N/A"*

If yes, please specify Rabbi and Congregation

Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply*

Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* *

Does your child have an EpiPen?**

YesNo

Does your child own a pair of Teffilin? **

YesI would like the Rabbi's help in purchasing a pairNo, I will purchase a pair on my own

Do you have a date set for the celebration?*

Yes, Its setRoughly, still planningNot yet

Where will the celebration take place?

Will there be a Torah reading at the celebration?

YesNoNot Sure

What would you most like us to focus on? )*

Who should the Chabad LES team contact in an emergency if both parents cannot be reached?

Emergency Contact**

First Name Last Name Phone Number

Relationship *

Emergency Contact**

First Name Last Name Phone Number

Relationship *

Know a family who would be interested in Bar Mitzvah Lessons or future programs?
Please include their name and number, and we will reach out to them.
Thank you for helping us grow our community, one wonderful family at a time.

Name/Number

I would like to receive news and updates by email

Please note that registration serves as an initial application.
Chani will contact you personally to confirm details, answer any questions, and match your child with the right mentor for their journey

Bar Mitzvah Lessons

Childs Information

Parent's Information

Medical Information

Bar Mitzvah Preparation

Emergency Contacts

The Best Compliment Is a Referral :)