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Bar Mitzvah Lesson Sign-up

Your Information:
Full Name:*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail:*
Child Information:
Full Name*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
Time of Day
Hour Minutes
Is the child's biological mother Jewish*
Is the maternal grandmother born Jewish*
Preferred study day of*
Payment Information:
Bar Mitzvah lessons prices:

$45 per 30 minute lesson

$55 per 45 minute lesson

$80 per 60 minute lesson
I would like to pay for the following amount of 30 minute lessons:

2 lessons - $905 lessons -$22510 lessons - $45015 lessons - $67520 lessons - $810
I would like to pay for the following amount of 45 minute lessons:

2 lessons - $1105 lessons -$27510 lessons - $55015 lessons - $82518 lessons - $990
I would like to pay for the following amount of 60 minute lessons:

1 lessons - $802 lessons -$1604 lessons - $3205 lessons - $4006 lessons - $480
Total:

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 2.9%

Payment:

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We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

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100% of the proceeds of this donation or payment benefit Chabad of the North Peninsula.
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