1. ABOUT YOUR DAUGHTER Daughter's Full Name* First Name Last Name Hebrew Name (if known) Date of Birth* 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School* School Year (2026)* Year 5Year 6 Daughter's Email Daughter's Mobile Has your daughter had any previous Jewish education? If yes, please tell us briefly. Natural mother Jewish?* YESNO Conversions/adoptions?* YESNO PARENTS/GUARDIAN DETAILS Parent/Guardian 1 Full Name* First Name Last Name Relationship to child* Mobile* Email* Address* Street Address Street Address Line 2 City State / Territory Post CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Parent/Guardian 2 Full Name* First Name Last Name Relationship to child* Mobile* Email* Address If different from Primary Parent/Guardian Street Address Street Address Line 2 City State / Territory Post CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Additional Information Is there anything we should know to help your daughter have the best possible experience? For example: learning needs, accessibility requirements, family circumstances or other relevant information. Planning a Bat Mitzvah at Chabad? Most families choose to celebrate their daughter’s Bat Mitzvah with a ceremony at Chabad North Shore. A Shule ceremony includes: Dvar Torah delivered by the Bat Mitzvah girl Personal address from the Rabbi Siddur presentation Opportunity for parents to speak Sponsored Kiddush For Shabbat morning celebrations, family call-ups to the Torah Ceremony fee Chabad Shule members: Included with membership Non-members: $500 Dvar Torah preparation If you would like your daughter to deliver a Dvar Torah, Rebbetzin Fruma Schapiro can prepare it with her in individual lessons. $85 per lesson. Kiddush Sponsorship Families can choose from the available Kiddush options. Pricing and arrangements are discussed separately with the office. Fees at a Glance Members Non-members Bat Mitzvah Course* $1,000 $1,350 Shule Ceremony Included $500 Dvar Torah preparation $85/lesson $85/lesson Kiddush Sponsorship By arrangement By arrangement * Course enrolment requires a $250 deposit, which goes towards the course fee. Are you considering holding your daughter’s Bat Mitzvah ceremony at Chabad?* YesNoMaybe — I’d like to know more What would be your service of preference?* Friday NightShabbat MorningNot sure yet Preferred Bat Mitzvah date If you have a date in mind, please enter it below. This is not a confirmed booking. 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month2029202820272026 Year Are you currently a member of Chabad's Shule?* YesNo Would you like to become a member? Yes! Please contact me with more informationNot at the moment, but may be interested at a later stageNo DOCUMENTATION Please bring-in your original Ketubah or that of your parents (Jewish marriage certificate) and your child’s birth certificate. To complete your daughter’s enrolment, please provide the following documents where applicable. Proof of Jewish status Please email a copy of the following: Mother’s Ketubah (original must be brought into office as well) Mother’s birth certificate Daughter's birth certificate Conversion documentation, if applicable If you're do not have all documentation at this time, please complete the form and we’ll contact you. Terms and Conditions By submitting this enrolment, I: Give permission for my daughter to participate in the Bat Mitzvah Course and associated activities. Agree to pay the course fees according to the payment arrangement selected above. Acknowledge that Chabad North Shore will take reasonable care during all activities and release and indemnify Chabad North Shore, its employees and officers from claims arising from my daughter’s participation in the program. Give permission for photos and videos of my daughter taken during the program or associated activities to be used by Chabad North Shore for community and promotional purposes. If I do not wish for my daughter’s image to be used, I will contact Rebbetzin Fruma Schapiro. Confirm that the information provided in this form is true and correct and agree to provide any required supporting documentation. By entering my full legal name below, I confirm that I have read and agree to the above. I have read and agree to the Terms & Conditions above.* Yes Parent/Guardian Full Legal Name* Course Enrolment & Payment Rosh Hashanah Enrolment Offer Complete your daughter’s enrolment by Rosh Hashanah and receive $100 off the course fee. Members Non-members Course Fee $1,000 $1,350 Deposit Due on Enrolment $250 $250 The $250 deposit forms part of the total course fee and is not an additional charge. Payment Options* Chabad Shule Member's discount applied Pay Deposit: $250Pay Full Course Fee: $1000 todayPay Deposit and the balance in 2 instalmentsPay Deposit and the balance in 3 instalmentsPay Deposite and I would like to speak to someone about an alternative payment plan Payment Options* Pay Deposit: $250Pay Full Course Fee: $1350 todayPay Deposit and the balance in 2 instalmentsPay Deposit and the balance in 3 instalmentsPay Deposite and I would like to speak to someone about an alternative payment plan Total $0.00 Payment Details Payment Method* Credit CardDirect Debit * Credit Card We accept Visa, MasterCard, American Express Credit Card Number Security Code1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration Year Bank:* Account Name:* BSB:* Account Number:* Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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