Bnai Mitzvah Application

In case of financial hardship, limited scholarship funds may be available for qualified applicants. Please contact Zach Lasker ([email protected]) before filling out the application.

Please complete this form in its entirety. If you have any questions, please call Alba Arzu at 323-876-8330 ext. 1007 or via email at [email protected]

STUDENT NAME

* Student First Name

Student Middle Name

* Student Last Name

* Student Full Hebrew/Yiddish Name

PARENT 1

Please use formal English name

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Mobile Phone

* Parent 1 Email

* Parent 1 Background Information

	Reform
	Conservative
	Orthodox
	Reconstructionist
	Spiritual but not Religious
	Atheist
	Non-Jewish

Parent 1 Full Hebrew/Yiddish Name

Parent 1 Profession

PARENT 2

Please use formal English name

Parent 2 First Name

Parent 2 Last Name

Parent 2 Mobile Phone

Parent 2 Email

Parent 2 Background Information

	Reform
	Conservative
	Orthodox
	Reconstructionist
	Spiritual but not Religious
	Atheist
	Non-Jewish

Parent 2 Full Hebrew/Yiddish Name

Parent 2 Profession

* PARENTS' STATUS

Married
Divorced
Widowed
Re-Married
Blended
Single

SIBLINGS FORMAL ENGLISH NAME (if applicable)

Sibling 1 Name

First Name

Middle Name

Last Name

Sibling 2 Name

First Name

Middle Name

Last Name

Sibling 3 Name

First Name

Middle Name

Last Name

GRANDPARENT NAMES

Grandparent 1

* Grandparent 1 First Name

* Grandparent 1 Last Name

* Grandparent 1 Status

	Living
	Deceased

Grandparent 2

Grandparent 2 First Name

Grandparent 2 Last Name

Grandparent 2 Status

	Living
	Deceased

Grandparent 3

Grandparent 3 First Name

Grandparent 3 Last Name

Grandparent 3 Status

	Living
	Deceased

Grandparent 4

Grandparent 4 First Name

Grandparent 4 Last Name

Grandparent 4 Status

	Living
	Deceased

Address

* Street Address

Unit#

* City

* State

* Zip

* Home Phone

Parent 2 Address (only if different than parent 1)

Street Address

Unit#

City

State

Zip

Home Phone

STUDENT STATUS

* Student Lives With:

Both Parents
Parent 1
Parent 2
Other / Please specify below

Other

Please list any activities at TIOH in which parent(s) is/are currently involved:

Please list any Jewish organizations and/or activities in which parent(s) is/are currently involved:

Please list any non-Jewish organizations and/or activities in which parent(s) is/are currently involved:

Please explain any special circumstances which would be helpful for us to know about. (Does your student have any learning disabilities or special medical circumstances which we might need to be aware of and sensitive towards? If necessary, please send additional information to Rabbi Calvin; [email protected]).

B'NAI MITZVAH INFORMATION

* Date when Student turns 13:

(mm/dd/yyyy)

Shacharit B'nai Mitzvah Ceremony
Our traditional morning service begins at 10am.

Mincha/Havdallah B'nai Mitzvah Ceremony
Families may instead choose to celebrate with a Mincha (afternoon) B'nai Mitzvah ceremony beginning at 4:30pm, which includes a Havdallah service to transition from Shabbat into the regular rhythm of the week. A supplemental fee will be charged to cover our added costs related to musicians, security, maintenance, and a tech engineer.

• $1,000 supplemental fee if your family is also renting space on campus for a reception
• $2,000 supplemental fee without a reception

If you have a specific date request, please note your top four choices here (in order of preference):

* 1st Choice

(mm/dd/yyyy)

* 1st Choice Ceremony Time

	AM Shacharit Ceremony
	PM Mincha/Havdallah Ceremony

* 2nd Choice

(mm/dd/yyyy)

* 2nd Choice Ceremony Time

	AM Shacharit Ceremony
	PM Mincha/Havdallah Ceremony

* 3rd Choice

(mm/dd/yyyy)

* 3rd Choice Ceremony Time

	AM Shacharit Ceremony
	PM Mincha/Havdallah Ceremony

* 4th Choice

(mm/dd/yyyy)

* 4th Choice Ceremony Time

	AM Shacharit Ceremony
	PM Mincha/Havdallah Ceremony

Please let us know if and with whom you would like to share your date or other special circumstances that can help us pick a date that is a good match for your family.

* Student Preferred Pronouns

He/Him
She/Her
They/Them

Other Pronoun

* Name of Current Religious/Day School & Grade

* When did your student start Religious/Day School?

* Did your student have any previous Religious/Day School training? If so, when and where?

If not a Briskin Elementary student, where does your child attend school?

Thank You

B'nai Mitzvah Deposit Fee and Payment Agreement

$300 Due Upon Application Submission

This deposit fee is to secure a date for your simcha.

The remainder of your B'nai Mitzvah fee, which will be billed to you in your myTIOH portal one year before your simcha, includes the following:

B'nai Mitzvah Preparation Fee This includes meetings with Rabbi and Cantor, up to 26 private tutoring sessions, Rehearsal with the Cantor, and is in addition to Temple Membership and all Religious School tuition and fees.

Shabbat Booklet Based on information provided by the family the TIOH will produce a booklet for use during the service Shabbat that includes a welcome, information about the service, the weekly Torah portion, a personal message from the family and the student, a description of the Mitzvah project. The booklet is informational, personal and a keepsake for your guests.

We will provide celebratory candy for use during the ceremony.

Security (Saturday Morning) The fee also helps defray the cost of security during your ceremony from approximately 8:00 a.m. to 12:00 p.m. on the morning of the B'nai Mitzvah.

Supplemental fees may include:
• Additional tutoring sessions if needed
• Zoom access and video recording of the ceremony
• Rental of space for an oneg or reception
• Additional security if needed

Mincha/Havdallah B'nai Mitzvah Ceremony
Families may instead choose to celebrate with a Mincha (afternoon) B'nai Mitzvah ceremony beginning at 4:30pm, which includes a Havdallah service to transition from Shabbat into the regular rhythm of the week. A supplemental fee will be charged to cover our added costs related to musicians, security, maintenance, and a tech engineer.

• $1,000 supplemental fee if your family is also renting space on campus for a reception
• $2,000 supplemental fee without a reception

Cancelation Policy

We acknowledge and understand that should we fail to make any of the required payments we will surrender the assigned date and the B'nai Mitzvah will be canceled.

In the event the B'nai Mitzvah is canceled the refund of amounts paid will be calculated as follows:

• If canceled more than 12 months in advance of the confirmed event date the refund will be 100%.

• If canceled between 4 and 12 months prior to the confirmed event date, we will give you a prorated refund based on the number of full months remaining until the event.

• If canceled 3 or less months prior to the confirmed event date, the family will not be entitled to any refund.

Additional Tutoring

In the event you and your student's tutor agree that extra sessions are advisable (in addition to the 26 discussed above) you agree that your account will be charged for a minimum of 5 half hour sessions at the rate of $60 per half hour. Should all five not be required the balance will be refunded to you. In the event more than five additional tutoring sessions are necessary you agree to be charged at the same rate per session

* I/We have read the Standards and Requirements for B'nai Mitzvah students and I/We agree that the student will complete a minimum of grades 5 and 6 in either TIOH's Briskin or Religious School and grade 7 in the Teen Program.

I/WE AGREE

By entering your account details below, you are authorizing your signature, confirming your student's B'nai Mitzvah, and authorizing the $300 deposit fee.