Bar Mitzvah Application - Elwood Shule.

Please complete our online form, or download a copy to print here.

Date of Bar Mitzvah
English
MM slash DD slash YYYY
Hebrew
MM slash DD slash YYYY
Parsha
MM slash DD slash YYYY
Child's Details
Full name of child
First Middle Last
Is this the name that appears on child’s birth certificate?
What was his original name?
Name child likes to be called (eg Thomas: Tommy/Tom)
Full Hebrew name of child
Is child a
Date of Birth
Time

: Hours

Minutes

AM/PM
Hebrew date
Place of Birth
City State / Province / Region Country
Name of person(s) to whom all information regarding the Bar Mitzvah should be sent
Name
Address
Phone Number Home
Business
Mobile
Email
Relationship, if any, to child

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Family Information
All questions must be answered in full unless the child is adopted and the information requested is unavailable
Fathers Information
Full name of natural father of child
Hebrew name of natural father of child
Was natural father of child born Jewish
Did conversion to Judaism take place?
Date of conversion
Name of presiding Beth Din

Please attach copies of supporting documentation. Upload field is located at the end of the form.
Is/was natural father a
Mothers Information
Full name of natural mother of child
Maiden name of natural mother of child
Hebrew name of natural mother of child
Was natural mother born Jewish?
Did conversion to Judaism take place?
Date of conversion
If this date is after birth of the child, did the Beth Din convert child as well?
Name of presiding Beth Din

Please attach copies of supporting documentation. Upload field is located at the end of the form.
Were natural parents of the child married under the auspices of an Orthodox Synagogue and/or Rabbi?
Please name the Synagogue and/or the officiating Rabbi
As the parents were not married under the auspices of an Orthodox Synagogue and/or Rabbi, please provide other supporting documentation that the parents are Jewish – this can be their parents’ Ketubah (Jewish marriage document) or a supporting letter from an Orthodox Rabbi. If such documentation is not available the Rabbi must be consulted as soon as possible. Upload field is located at the end of the form.
File upload
Drop files here or

Max. file size: 128 MB.
Are natural parents living together?
Is child adopted?
Is child living with a legal guardian other than natural or adoptive parent?
Natural parents are no longer living together
Why are parents are no longer living together?

e.g. divorced, death of spouse etc.
Is natural father still living?
Is natural mother still living?
With whom is child actually living?
Father's information
What is the current address of natural father?
Home Phone
Business Phone
Mobile Phone
Mothers's information
What is the current address of natural mother?
Home Phone
Business Phone
Mobile Phone
These question to be answered only if child is adopted
Date of adoption
Full name of adoptive father
Father’s Hebrew name
Address
Home Phone
Business Phone
Mobile Phone
Full name of adoptive mother
Address
Home Phone
Business Phone
Mobile Phone
Was child born Jewish
If so, do you have official documentation supporting this fact?
Max. file size: 128 MB.
As the child was not born Jewish, was adoption properly registered with a Beth Din?
Please attach copies of any such documentation
Max. file size: 128 MB.
This question to be answered if child is living with legal guardian(s) other than natural or adoptive parent:
Name of guardian(s)
Address
Home Phone
Business Phone
Mobile Phone
Relationship, if any, to child

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Childs education
Which school does child attend?
If the school is a Jewish day school, how long has child attended?
If the school is not a Jewish day school, where does child attend Hebrew classes?
How long has he been attending such Hebrew classes?
Child attends Shabbat services at:
Name of Bar Mitzvah teacher:
Bar Mitzvah Portion
Name of Parsha (weekly portion):
Please indicate which of the following the Bar Mitzvah boy will read (you may tick more than one box):
- Maftir and Haftorah
- Haftorah only
- Aliya only
- Whole Parsha
- Part of the Parsha
Please indicate exactly which sections:
Kiddush
Are you having a Kiddush in the Karafka Hall?
If regular minyan goers not included, please note $500 (Elwood Members) or (non members) $700 hall hire fee.
Caterer

Only Kosher caterers under a recognized orthodox Rabbinical authority may be used
Current Bar Mitzvah fees for Shule members are $275.00
Current Bar Mitzvah fees for non-Shule members are $500.00
Please ensure that you attach a copy of all relevant documentation.

In all cases this must include a copy of child’s full birth certificate, natural parents’ Ketubah (Jewish marriage document) if available or any other documentation that would help prove the Jewish status of the child.
- In the event of illness or injury to my child whilst attending Elwood Shule’s Bar Mitzvah Program, I hereby authorise the staff member in charge of my child to consent to emergency medical arrangements on my behalf as deemed necessary.
- I hereby give permission for my child to attend excursions organised as part of the Elwood Shule Bar Mitzvah Program
- I hereby give permission for my child’s photographs/videos to be used for publicity & promotion of the program.
- I hereby certify that to the best of my knowledge the above information is true and correct in every detail.
Document upload
Drop files here or

Max. file size: 128 MB.
Name of person completing this form*
Date*
Signature*
Acknowledgement

Please note, that lodgement of this form does not constitute confirmation of your booking. You will be notified concerning such confirmation in due course. An interview with the Rabbi may be required prior to confirmation at which time original documents may need to be presented.

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Date of Bar Mitzvah

Child's Details

Name of person(s) to whom all information regarding the Bar Mitzvah should be sent

Family Information

Fathers Information

Mothers Information

Natural parents are no longer living together

Father's information

Mothers's information

These question to be answered only if child is adopted

This question to be answered if child is living with legal guardian(s) other than natural or adoptive parent:

Childs education

Bar Mitzvah Portion

Kiddush

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