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Depreciated 2023-01-11 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 Tamar Union 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)

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

(mm/dd/yyyy)

* 2nd Choice

(mm/dd/yyyy)

* 3rd Choice

(mm/dd/yyyy)

* 4th Choice

(mm/dd/yyyy)

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?

* 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

CONFIRMATION - CONTRACT

By entering your name below, you are authorizing your signature and confirming your student's B'nai Mitzvah.

* Signature of Parent or Legal Guardian

* Signature of B'nai Mitzvah

Thank You

B'nai Mitzvah Fee and Payment Agreement

$3000

This fee 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 Morning Booklet Based on information provided by the family the TIOH will produce a booklet for use during the service Shabbat morning 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 2:00 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

Payment Terms

We require a minimum $300 deposit at time of signing the agreement. The balance will be due monthly in up to nine (9) installments by automatic credit card, or electronic check (ACH) payment. We agree to enroll in the automatic payment system below and preauthorize the monthly payment. 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 cancelled.

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

If cancelled more than 12 months in advance of the confirmed event date the refund will be 100%.
If cancelled 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 cancelled 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 $45 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

Recurring Payment

I want to make a recurring payment

Please enter the number of periods

Please bill me each period in the amount of

I agree to have my account information used to bill me as per the terms above. Additional payments will be made until the total number of periods are reached.

Recurring Total:

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Increase my donation by 3% to cover credit card fees. Please select YES to increase your donation.

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