CM_AD14a.jpg 

Bar Mitzva lessons are at Chabad of Maple  - 9960 Dufferin Street Unit 13 (in the Higland Farms Plaza) generally on Sunday mornings and Wednesday afternoon / evenings. (Alternative arrangements can be made)

Please fill out this registration form below to the best of your ability. Upon receipt of this form I will contact you and arrange the lesson times.

For questions or help filling out the form please contact Rabbi Chezky Deren  647.883.6372 or [email protected]  
 

Student Information

First Name

 

Last Name

Hebrew Name

 

DOB

Street Address

  City
Province     Postal Code
Home Phone     Email
School     Hebrew School
Grade        
Jewish Birthday     Bar Mitzvah Parsha
Date of Aliya and Reading from the Torah     Where is Aliya taking place?
Shul Affiliation      
Tefillin
Where will Tefillin be purchased from?        
Parent Information
Mother's Name     Father's Name
Hebrew Name     Hebrew Name
Mother's Work     Father's Work
Mother's Cell     Father's Cell
Is Mother Jewish?     Is Father Jewish?
Mother's Mother's Name (Hebrew)     Father's Mother's  Name (Hebrew)
Mother's Father's Name (Hebrew)     Father's Father's Name (Hebrew)
Are mothers parents both Jewish? If not, Please elaborate.     Have any family members been adopted or converted to Judaism? If yes please elaborate.

Payment & Fees: 

The cost per a lessons is $45. Regular lessons are half hour. At the initial meeting we will discuss the number of lessons needed. (45 minute Lessons are $65)

 

  Fees

$45.00 
Half hour Lesson

 

 

       $65.00
45 minute lesson

Fees's for lessons are due at the end of each month.
I will be paying by: Credit Card  Other (Cheque, Cash, or E-transfer to [email protected])

Card Type   Card Number
Expiration Date     Security Code            
Important

I confirm that all the details provided above are accurate, to the best of my knowledge.

Parent's Signature: 

For help filling out the form please contact Rabbi Chezky Deren 
647.883.6372 or [email protected]