Bat Mitzvah Reservation - Chabad of Parkland

Family Name*
Bat Mitzvah Girl's First Name*
Bat Mitzvah Girl's Hebrew Name
Birth Date

Month Day Year
Father's Name*
First Name Last Name
Father's Hebrew Name
Father's Cell

Area Code Phone Number
Father's Email*
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's Cell

Area Code Phone Number
Mother's Email*
Siblings
Bat Mitzvah Date Preference

Month Day Year
Time of Ceremony Preference
No. of attendees expected (approx.)
Location/Venue of Ceremony
Ceremony Day

Friday Evening (Kabbalat Shabbat)Saturday night (Havdalah)SundayOther (Holiday)
Preparation*

12 Lessons in Bat Mitzvah Club with Estie + 3 Private with Rabbi Gutnick [$750 Non-Member $600 Member]
Additional Comments Optional

Deposit Payment ($100)* Applied to Lessons

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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Street Address

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