Bar Mitzvah Inquiry

Child's name*

First NameLast Name

Chosen Hebrew name of child*

Secular date of birth*

MonthDayYear

Hebrew date of birth (if not known, write unknown)*

Father's name*

First NameLast Name

Father's Hebrew name*

What religion was the biological father born into?*

Mother's name*

First NameLast Name

Mother's Hebrew name*

What religion was the biological mother born into?*

What religion was the maternal grandmother born into?*

What religion was the paternal grandmother born into?*

Have there been any adoptions in the family history?*

YesNo

If yes, who?

Preferred date of ceremony*

MonthDayYear

Is the child a Kohen, Levi, or Yisroel?*

KohenLeviYisroelUnknown

Address*

E-mail*

Phone Number*

Area CodePhone Number

Fill out this form if you are interested in celebrating your child's bar mitzvah at Chabad of The Hamptons