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Application for B'nai Mitzvah Program
Name:
Requested Date for B’nai Mitzvah:
Requested Time:
Birthdate:
Parents’ Names:
Mailing Address:
Parents’ tel. day:
Parents’ tel. eve:
Parents’ email:
Parents’ email 2:
Parents’ fax:
Student Email:
B’nai Mitzvah Location:

   Why does your child wish to have an AdventureRabbi bar or bat mitzvah?
  
   What is your current or recent synagogue relationship?
  
   What formal religious education has your child received?