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Bar Mitzvah Inquiry

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

Child's name*

First Name Last Name
Chosen Hebrew name of child*
Secular date of birth*

Month Day Year
Hebrew date of birth (if not known, write unknown)*
Father's name*

First Name Last Name
Father's Hebrew name*
What religion was the biological father born into?*
Mother's name*

First Name Last 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?*

Yes No
If yes, who?
Preferred date of ceremony*

Month Day Year
Is the child a Kohen, Levi, or Yisroel?*

Kohen Levi Yisroel Unknown

Address*

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

E-mail*
Phone Number*

Area Code Phone Number
Should be Empty:

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