Bnai Mitzvah Date Request Form - Form

B'nai Mitzvah Date Request Form
Dates are filled on a first come, first served basis with your $500 deposit.

Student's Name:

* First Name

* Last Name

Email Address (if they have)

Cell Phone Number (if they have)

* Hebrew Name

Please confirm your contact information

* Guardian 1. First Name

* Last Name

Email Address

Mobile Phone Number

Gaurdian 2. First Name

Last Name

* Email Address

* Mobile Phone Number

Selecting a Date:
Please note: B'nai Mitzvah are not scheduled for six weeks starting mid June through the end of July.

Date and Time Requested: (Please list 3 choices)

* 1. Service Time Request

* Date Request

2. Service Time Request

* Date Request

3. Service Time Request

* Date Request

* Are there any special circumstances we should be aware of?

Celebrate Your Simcha:

* Social Hall Information or Reservation

Friday Night Shabbat DinnerSaturday Kiddush LunchReception / PartyWe will not be using Kol Tikvah's Social HallI would like more information before making a decision.

Click HERE for the Social Hall Rental Agreement for Friday Night Shabbat Dinner and Saturday Kiddush Lunch.

Click HERE for the Social Hall Rental Agreement for Party/Reception.

*Your date will be held as long as you are a member in good standing.
* The B’nai Mitzvah family must be a paying member in good standing in the fiscal year of the B’nai Mitzvah.
* Teen Tuesday: All seventh graders are required to participate in our Teen Tuesday program,
which includes our teen philanthropy program, Tzedakah Teens. Tuesdays 6:00pm-8:00pm.

A one-time B’nai Mitzvah fee covers all expenses related to the service, including individualized
instruction, all preparatory materials, study and rehearsals with the clergy, the Friday night Oneg
Shabbat sponsorship, large 5lb. challah, candy & juice and Teen Tuesday.

The total fee is $3,600 for those that have reserved a date prior to January 2026. Effective
January 1, 2026, B’nai Mitzvah fees may increase.

* Your Bar/Bat Mitzvah deposit of $500, to secure your date will be deducted from your Bnai Mitzvah Fee.

Your Bar/Bat Mitzvah deposit of $500, to secure your date will be deducted from your Bnai Mitzvah Fee.

I understand that I will be charged the non-refundable deposit, for this initial fee, upon confirmation of my Bar/Bat Mitzvah date.

All fees must be paid in full prior to the B’nai Mitzvah. The remaining B’nai Mitzvah fees may
be made in monthly payments with the final payment due 3 months before the B’nai Mitzvah, or
due in 3 installments; 1 year prior, 6 months prior and 3 months prior to the B’nai
Mitzvah. These payments will automatically be charged to the credit card on file at the time they
are due.

Please charge my credit card for the balance due after my deposit.Please charge my credit card monthly (charges will start the month after this form is received.)Please charge my credit card in the 3 installments listed above.I would like to arrange different payment options. Please call me.

We look forward to sharing in your simcha!

Please call the temple office at 818-348-0670 ext. 200 with any questions.