B'nai Mitzvah Service Information Form

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* First Name

Middle Name

* Last Name

Bar/Bat Mitzvah Date and location

Celebrant's Hebrew Name

Parents names:

* Father's Hebrew Name

* Mother's Hebrew Name

* Email Address

* Phone Number

* Please list Siblings and ages

* Please list Grandparents names. Kindly indicate the following: married, divorced, widowed, living or deceased

* Please list Great-Grandparents names if desired. Please indicate the following married divorced widowed living or deceased.

* JUDAIC GIFT - Only ONE gift is presented by all siblings, If your choice of gift is something other than the items listed below, please check with B’nai Mitzvah Coordinator Stephanie Brovenick. The Talit will be placed on the child's shoulders by all the grandparents present. If there are no siblings or grandparents, appropriate substitutions can be made in consultation with the Clergy.

* Person presenting gift.

* First Aliyah - Please list relationships (ie: Grandparents Myra & Benjamin Singer and Sarah & Herman Levine)

Second Aliyah - Please list relationships (ie: Aunt & Uncle Susie & Marc Cohen)

* Tutor

Wed, January 23 2019 17 Sh'vat 5779

B'nai Mitzvah Service Information Form

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