Bar Mitzvah Academy – Enrollment Form

Student’s Full Name

Date of Birth

Current Grade in School

Hebrew Reading Ability

None

Some (basic letters and vowels)

Moderate

Fluent

Parent/Guardian 1 Name

Relationship to Student

Father

Mother

Guardian

Other

Email

Phone Number

Parent/Guardian 2 Name

Relationship to Student

Father

Mother

Guardian

Other

Email

Phone Number

Was the student's mother born Jewish?

Yes

Converted (please specify below)

If converted, denomination/details

Jewish Affiliation

Reform

Conservative

Orthodox

Secular

Just Exploring

Other

Goals for your child’s Bar Mitzvah experience

Learn Hebrew reading basics

Understand Jewish values and traditions

Prepare a D’var Torah (speech)

Learn to lead basic prayers

Chant from the Torah (with outside tutoring)

Gain Jewish identity & confidence

Connect with Jewish community

Other (please specify)

Other goals (optional)

Would you like to explore Jewish learning as a parent?

Yes

Maybe – tell me more

Bar Mitzvah Academy Tuition

Program Tiered Tuition: We offer three monthly pricing tiers to make Bar Mitzvah Academy accessible to as many families as possible:

• Community Tier – $50/month: A reduced rate for families who need it. Includes full access to live weekly classes, all digital materials, and ongoing support—nothing is left out.

• Standard Tier – $75/month: This is the actual cost of running the program. If you’re able to pay this amount, it helps us continue offering high-quality content and support to every student.

• Supporter Tier – $100/month: For families who are able and willing to help sponsor others. You’ll receive everything in the Standard Tier, plus our heartfelt thanks for making this program possible for more children.

Consent & Submission

I confirm that the information provided is accurate to the best of my knowledge.

I understand this program does not include chanting a specific Torah portion.