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			<h1 class="article-header__title js-article-title js-page-title">Bat Mitzvah Form</h1>
		
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We have prepared the following guidelines to assist you in planning for this joyous occasion.\u003c/p\u003e\n","5_name":"doubleclickTo","5_qid":5,"5_type":"control_text","5_order":2,"26_text":"Who can become Bat Mitzvah at Chabad?","26_subHeader":"","26_headerType":"Default","26_name":"clickTo26","26_qid":26,"26_type":"control_head","26_order":3,"6_text":"\u003cp style=\"text-align: justify;\"\u003eIn order to hold your child\u0026#39;s ceremony and/or celebration at Chabad, the following requirements must be met:\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003e\u003cb\u003eYour child must be born to a Jewish mother or converted under Orthodox auspices.\u003c/b\u003e If the mother or maternal grandmother was converted to Judaism, please set up an appointment with the Rabbi to determine if those conversions met with the Chabad standards for conversion.\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003eIf the prospective Bat Mitzvah girl, her\u0026#160;mother or maternal grandmother are adopted, we will need documentation that shows that the birth mother was Jewish or that a proper conversion was performed.\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003eAccording to Jewish Law, religious identity is determined solely by the mother and an intermarried family where the father is not Jewish has no effect on the religious identity of the child.\u003c/p\u003e\n","6_name":"doubleclickTo6","6_qid":6,"6_type":"control_text","6_order":4,"27_text":"Confirmation","27_subHeader":"","27_headerType":"Default","27_name":"clickTo27","27_qid":27,"27_type":"control_head","27_order":5,"22_text":"Please Confirm","22_message":"","22_labelAlign":"Auto","22_required":"No","22_options":"I affirm that the prospective Bat Mitzvah girl meets the above criteria. If not please email rabbi@jewishsouthlake.com before completing this form.","22_special":"None","22_allowOther":"No","22_otherText":"Other","22_calculateOther":"No","22_spreadCols":"1","22_selected":"","22_minSelection":"","22_maxSelection":"","22_description":"","22_name":"input22","22_qid":22,"22_type":"control_checkbox","22_order":6,"28_text":"Age \u0026amp; Dates","28_subHeader":"","28_headerType":"Default","28_name":"clickTo28","28_qid":28,"28_type":"control_head","28_order":7,"7_text":"\u003cp style=\"text-align: justify;\"\u003eBat\u0026#160;Mitzvah is the day on which a child becomes responsible for Mitzvot and accountable for both positive and negative behaviors under Jewish law. According to the Talmud, this takes place at age 12. This happens automatically on their Jewish birth date, regardless of the way the day is marked. The ceremony and celebration should take place as close to the Jewish birthday as possible. 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<form class="userform-form" action="" method="post" name="form_6797636" id="6797636" accept-charset="utf-8"><input type="hidden" name="formID" value="6797636" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_25" class="form-input-wide"> <div class="form-header-group"><h2 id="header_25" class="form-header">Intorduction</h2></div> </li><li class="form-line" id="id_5"><div id="cid_5" class="form-input-wide"> <div id="text_5" class="form-html"><p style="text-align: justify;">At Chabad of Southlake, our primary goal is preparing our children to live Jewish lives with pride, with knowledge, and enthusiasm. When your child reaches the age of Bat Mitzvah, we share with your family the privilege and responsibility of welcoming her into the adult Jewish community. Together, we hope to instill the meaning and significance of the occasion, to celebrate appropriately, and to honor your child's place among the Jewish people. We have prepared the following guidelines to assist you in planning for this joyous occasion.</p>
</div> </div></li><li id="cid_26" class="form-input-wide"> <div class="form-header-group"><h2 id="header_26" class="form-header">Who can become Bat Mitzvah at Chabad?</h2></div> </li><li class="form-line" id="id_6"><div id="cid_6" class="form-input-wide"> <div id="text_6" class="form-html"><p style="text-align: justify;">In order to hold your child's ceremony and/or celebration at Chabad, the following requirements must be met:</p>

<p style="text-align: justify;"><b>Your child must be born to a Jewish mother or converted under Orthodox auspices.</b> If the mother or maternal grandmother was converted to Judaism, please set up an appointment with the Rabbi to determine if those conversions met with the Chabad standards for conversion.</p>

<p style="text-align: justify;">If the prospective Bat Mitzvah girl, her mother or maternal grandmother are adopted, we will need documentation that shows that the birth mother was Jewish or that a proper conversion was performed.</p>

<p style="text-align: justify;">According to Jewish Law, religious identity is determined solely by the mother and an intermarried family where the father is not Jewish has no effect on the religious identity of the child.</p>
</div> </div></li><li id="cid_27" class="form-input-wide"> <div class="form-header-group"><h2 id="header_27" class="form-header">Confirmation</h2></div> </li><li class="form-line" id="id_22"><div class="form-label-top" id="label_22"><label for="input_22"> Please Confirm </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input-wide"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_22_0" name="q22_input22[]" value="I affirm that the prospective Bat Mitzvah girl meets the above criteria. If not please email rabbi@jewishsouthlake.com before completing this form." /><label id="label_input_22_0" for="input_22_0"><span>I affirm that the prospective Bat Mitzvah girl meets the above criteria. If not please email rabbi@jewishsouthlake.com before completing this form.</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_28" class="form-input-wide"> <div class="form-header-group"><h2 id="header_28" class="form-header">Age &amp; Dates</h2></div> </li><li class="form-line" id="id_7"><div id="cid_7" class="form-input-wide"> <div id="text_7" class="form-html"><p style="text-align: justify;">Bat Mitzvah is the day on which a child becomes responsible for Mitzvot and accountable for both positive and negative behaviors under Jewish law. According to the Talmud, this takes place at age 12. This happens automatically on their Jewish birth date, regardless of the way the day is marked. The ceremony and celebration should take place as close to the Jewish birthday as possible. As a child grows, the Jewish and secular birthdays may move weeks apart, we therefore need to make sure that your preferred date is indeed after your child's 12th Jewish birthday.</p>

<p style="text-align: justify;">We recommend scheduling Bat Mitzvahs at least 18 months prior to your child's 12th birthday. To choose a date, set up an initial meeting with the Rishi to determine your child's Jewish birthday. Your child's Bat Mitzvah must be in the year following that date, as close as possible to the date but not before it.</p>
</div> </div></li><li id="cid_29" class="form-input-wide"> <div class="form-header-group"><h2 id="header_29" class="form-header">Bat Mitzvah Ceremony and Preparation</h2></div> </li><li class="form-line" id="id_8"><div id="cid_8" class="form-input-wide"> <div id="text_8" class="form-html"><p style="text-align: justify;"><strong>Event Options</strong></p>

<p style="text-align: justify;"><strong>1. Weekday Evening &amp; Sundays: </strong>Can host a reception any day of the week and choose a ceremony type from the list below. <br />
<strong>2. Friday Night Candle Lighting Service:</strong> In a Friday evening service, the Bat Mitzvah girl leads the women and girls in the candle lighting and blessing. In the winter the candle lighting will be at the very beginning of the ceremony and in the summer, the candle lighting will be after the Bat Mitzvah ceremony but  before the Shabbat evening service. Please remember that videos and cameras are only allowed until the Candle lighting service. The Bat Mitzvah ceremony is followed by the Friday Night service for all guests to attend, conducted by the Rabbi. After the service, Kiddush will be made and the family of the Bat MItzvah girl can then host either a dinner or dessert reception.<br />
<strong>3. Saturday Evening Havdalah Service (winter months)</strong><br />
The service can begin anytime from 45 minutes after Shabbat ends. The ceremony will include<br />
the Havdalah service and then any of the ceremony types listed below</p>

<p style="text-align: justify;"><b>The party must be one at which the food that is brought in meets our Kashrut standards. </b>Chabad approves certain caterers, meats, and bakeries. Please speak to the Rabbi or Rishi for ideas and suggestions in this regard.</p>
</div> </div></li><li class="form-line" id="id_9"><div id="cid_9" class="form-input-wide"> <div id="text_9" class="form-html"><p style="text-align: justify;">The Bat Mitzvah girl will begin preparation classes at the determined time prior to her Bat Mitzvah. Classes are private, and are set up directly with the Rishi. Classes are held once a week for 30-45 minutes at a mutually convenient time. In consultation with the Bat Mitzvah boy and her parents a course of learning and preparation will be decided upon.</p>

<p style="text-align: justify;">We do not have a fee structure for Bat Mitzvah preparation, rather we suggest a $1,800 - $2,500 donation in honor of the Bat Mitzvah. <strong>NO ONE WILL BE TURNED AWAY DUE TO LACK OF FUNDS.</strong></p>
</div> </div></li><li class="form-line" id="id_10"><div class="form-label-top" id="label_10"><label for="input_10"> Name of Bat Mitzvah Girl<span class="form-required">*</span> </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q10_fullName[first]" id="first_10" autocomplete="given-name" />  <label class="form-sub-label" for="first_10" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q10_fullName[last]" id="last_10" autocomplete="family-name" />  <label class="form-sub-label" for="last_10" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_11"><div class="form-label-top" id="label_11"><label for="input_11"> Parent One<span class="form-required">*</span> </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q11_fullName11[first]" id="first_11" autocomplete="given-name" />  <label class="form-sub-label" for="first_11" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q11_fullName11[last]" id="last_11" autocomplete="family-name" />  <label class="form-sub-label" for="last_11" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_13"><div class="form-label-top" id="label_13"><label for="input_13"> Parent One E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input-wide"> <input type="email" class=" form-textbox validate[required, Email]" id="input_13" name="q13_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_15"><div class="form-label-top" id="label_15"><label for="input_15"> Parent One Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q15_phoneNumber[area]" id="input_15_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_15_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q15_phoneNumber[phone]" id="input_15_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_15_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_19"><div class="form-label-top" id="label_19"><label for="input_19"> Parent Two </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q19_fullName19[first]" id="first_19" autocomplete="given-name" />  <label class="form-sub-label" for="first_19" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q19_fullName19[last]" id="last_19" autocomplete="family-name" />  <label class="form-sub-label" for="last_19" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_20"><div class="form-label-top" id="label_20"><label for="input_20"> Parent Two E-mail </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input-wide"> <input type="email" class=" form-textbox validate[Email]" id="input_20" name="q20_email20" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_21"><div class="form-label-top" id="label_21"><label for="input_21"> Parent Two Phone Number </label><label class="label-message" for="input_21"> </label></div><div id="cid_21" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q21_phoneNumber21[area]" id="input_21_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_21_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q21_phoneNumber21[phone]" id="input_21_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_21_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_12"><div class="form-label-top" id="label_12"><label for="input_12"> Address<span class="form-required">*</span> </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input-wide"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q12_address[addr_line1]" id="input_12_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_12_addr_line1" id="sublabel_12_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q12_address[addr_line2]" id="input_12_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_12_addr_line2" id="sublabel_12_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q12_address[city]" id="input_12_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_12_city" id="sublabel_12_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q12_address[state]" id="input_12_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_12_state" id="sublabel_12_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q12_address[postal]" id="input_12_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_12_postal" id="sublabel_12_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q12_address[country]" id="input_12_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_12_country" id="sublabel_12_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_16"><div class="form-label-top" id="label_16"><label for="input_16"> Proposed Bat Mitzvah Date<span class="form-required">*</span> </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input-wide"> <div class="datetime-fields"><div class="dir_ltr date-fields"><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="month_16" name="q16_input16[month]" type="tel" size="2" maxlength="2" value="02" />  <label class="form-sub-label" for="month_16" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="day_16" name="q16_input16[day]" type="tel" size="2" maxlength="2" value="24" />  <label class="form-sub-label" for="day_16" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="year_16" name="q16_input16[year]" type="tel" size="4" maxlength="4" value="2025" />  <label class="form-sub-label" for="year_16" id="sublabel_year">Year</label></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_16_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />  <label class="form-sub-label" for="input_16_pick"><span> </span></label></span></div></div> </div></li><li class="form-line" id="id_17"><div class="form-label-top" id="label_17"><label for="input_17"> Questions / Comments </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input-wide"> <textarea id="input_17" class="form-textarea" name="q17_input17" cols="40" rows="6"></textarea> </div></li><li class="form-line" id="id_18"><div class="form-label-top" id="label_18"><label for="input_18"> I/We have read and agree to all of the above<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input-wide"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_18_0" name="q18_input18[]" value="Yes" /><label id="label_input_18_0" for="input_18_0"><span>Yes</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_24"><div class="form-label-top" id="label_24"><label for="input_24"> I/we would like to make a donation in honor of the Bar Mitzvah </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item simple-mode"><label id="label_input_24" for="input_24"><span>$</span></label><input type="number" class="form-textbox" id="input_24" name="q24_input24" value="" onkeypress="validateNumber(event)" /></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_23"><div class="form-label-top" id="label_23"><label for="input_23"> Payment </label><label class="label-message" for="input_23"> </label></div><div id="cid_23" class="form-input-wide"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_23_creditCard" name="q23_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_23_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_23_other" name="q23_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_23_other">Other</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q23_payment[cc_type]" id="input_23_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q23_payment[cc_number]" id="input_23_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_23_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q23_payment[cc_ccv]" id="input_23_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_23_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q23_payment[cc_nameOnCard]" id="input_23_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_23_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q23_payment[cc_exp_month]" id="input_23_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_23_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q23_payment[cc_exp_year]" id="input_23_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option></select>  <label class="form-sub-label" for="input_23_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2"></td></tr><tr class="billing_address hide"><th colspan="2">Billing Address</th></tr><tr class="billing_address hide"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q23_payment[addr_line1]" id="input_23_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_23_addr_line1" id="sublabel_23_addr_line1">Street Address</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q23_payment[city]" id="input_23_city" autocomplete="billing address-level2" />  <label 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value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option 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		<span class="footer-title" >Chabad of Southlake</span>
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