B'nai Mitzvah application form - Form - Aventura Turnberry Jewish Center

* Full Name of Child: First/Middle/Last

Born Jewish

YesNo

* Birthdate and time

Secular School Grade

* Best email to reach you

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Tribe

KohainLeviIsraeliteUnknown

Child lives with

Both ParentsMotherFatherOther

If other, please specify

Street Address

City, State, Zip

* Parent 1's Name

Home Phone

* Cell Number

* Email

Parent 2's Name

Home Phone if different

Cell Number

Both parents Jewish

yesno

If no, who was converted, and who was Converting Rabbi

In case of Emergency please call:

List 4 names and phone numbers.

List any allergies or medical information.

Date Preferred (first choice)

Date Preferred (second choice)

Please check all that apply

If lived in Israel, how many years?

We would love to present the B’nai Mitzvah with a certificate of eligibility for the $3,000 RootOne B*Mitzvah coupon that they will be able to use when they are old enough to enroll in an approved teen Israel summer program. For this reason, I as the parent/guardian authorize ATJC to share the B’nai Mitzvah’s name, date of birth, and contact information, as well as the parents' names and contact information with USY (United Synagogue Youth), the youth movement of the United Synagogue of Conservative Judaism.