Bar Mitzva Lessons - Chabad Maple Community Centre for Jewish Life

Bar Mitzva lessons are at Chabad of Maple - 9960 Dufferin Street Unit 4 (in the LCBO Plaza on the SW corner of Dufferin St. and Major Mackenzie Dr.) 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]