Before the bris I will need to know:

The Registration Form should be filled out after you have spoken with me and confirmed the time and date of the Brit Milah (and after the baby has been born). If you have not spoken with me or the baby has not yet been born, please do NOT fill out the Registration form.

Important! Please fill out the form carefully. Many parents are sleep deprived. All of the information on this form is for the parents of the baby (or babies), not the grandparents! Please review it at least once before you hit the "send" button.

Please punctuate and capitalize appropriately. Please do not use all capital letters or all lowercase letters. It will be greatly appreciated and save me a lot of time.

Please abbreviate wherever possible! For example, you may write St. instead of Street; 8.6 instead of 8 pounds 6 ounces; 4/26/10 instead of April 26, 2010; NY instead of New York, etc. Thank you.

If you are having a separate Baby Naming ceremony for your daughter (not boy/girl twins), please click here and fill in the Naming Registration form. This is for Naming ceremonies only.

If you need help with the Jewish names, please visit the Naming Guide section of my web site or call me. Also, I would suggest keeping the name a secret until the Bris.

Registration Form

Event

Day:     Date: (MM/DD/YYYY)   Time*:

(*This is the ceremony time! Please invite the guests for one-half hour earlier)




Father/Parent 1 (or Single Parent)


Last name:    First name:    Jewish name:

Status?    Is the Father/Parent 1 a convert to Judaism?



Mother/Parent 2


Last name:    First name:    Jewish name:

Status?    Is the Mother/Parent 2 a convert to Judaism?




Contact email address:

Contact cell phone number: ( ) -



Baby


Last name:    First name:    Middle name(s):    

Jewish name:
(If you haven't figured out the baby's Jewish name, please leave it blank and complete the rest of the form and submit.)

Date of birth? (MM/DD/YYYY)   Time of birth?

Birth weight? lbs. oz.   Birth Length?



Second Baby


Last name:    First name:    Middle name(s):    

Jewish name:

Date of birth? (MM/DD/YYYY)   Time of birth?

Birth weight? lbs. oz.   Birth Length?


Was it a c-section? Yes No

Was the baby adopted? Yes No Speak to Cantor Sherman

Was the baby born via surrogate? Yes No Speak to Cantor Sherman




Is there anything that would impede or affect the healing of the circumcision?
Yes No
If "Yes" please explain:


Is there any history of bleeding disorders in your families?
Yes No
If "Yes" please explain:


Is there any reason the baby cannot be circumcised?
Yes No
If "Yes" please explain:


Were there any previous pregnancies that went beyond six weeks?
Yes No.


Did you read and print the Supply List and Bris Instructions from my web site? Yes No.



Sister


Also, would you like to have a Naming for an older sister? Yes No.

If yes: Last name:     First name:     Middle name(s):

Jewish name:

Date of birth? (MM/DD/YYYY)



Home Address


(I will need directions only if you live in a new development or the address is not found on Google or Mapquest.
Please email the directions to: )

Street Address:     Apartment # (If applicable)

City:    State:    Zip:

Home phone number: ( ) -



Bris Address


Where is the event taking place?

(I will need directions only if it is a new development or the address is not found on Google or Mapquest.)
Please email the directions to: )

Name of Institution (if applicable):

Address:

City:    State:    Zip:

Phone number: ( ) -    or Email address:



Honors


The custom is for the parents of the baby to give out the honors at a Bris. The parents of the baby are not usually included in the ceremony. Individuals are not usually given multiple honors at a Bris and the same person should not be the Sandak at every Bris. Non-Jewish family and friends may be included in the ceremony. Bringing the baby in and out of the room at the beginning and at the end of the ceremony and holding the baby for the Naming portion of the ceremony may be given to non-Jewish family members or friends. The Sandak and Chair of Elijah honors should be given to Jewish family members or friends.

Please type the first name of the honoree ONLY. I do not need to know the relationship.
If there is more than one person at the Bris with the same first name, please include their last name.
I recommend keeping the Honors (and the baby's Jewish name) a secret until the Bris.

More information on how to distribute the honors and to whom.

The maximum number of people that can be included in the ceremony is nine (9). The maximum number of people per Honor is two (2) except for the Sandak which is one (1) only. If you need to include more than nine (9) people in the ceremony, they may be added in a line-up after the baby is brought in (before the Chair of Elijah) or you may have a group "Motzi" before the festive meal begins.

(If you haven't figured out the Honors, please leave the section blank and complete the rest of the form and submit.)

Bring Baby In    Additional Honor (If needed):

Chair of Elijah:     Additional Honor (If needed):

Sandak I (Hold for Bris): (This Honor is given to one person only.)

Sandak II (Hold for Naming):    Additional Honor (If needed):

Take Baby Out:    Additional Honor (If needed):

Name(s) of Great-Grandparent(s) attending?

Baby's Older Siblings (Names and ages)



Additional Information


Who referred you to me?

Last Name    First Name

Phone number? ( ) -   or Email address:


Did you give birth at:

Name of Institution:

City:     State:    Zip:

Phone number? ( ) -   or Email address:


Who is your Pediatrician? Last Name:   First Name:

Phone number? ( ) -   or Email address:


Who delivered your baby?

Last Name:   First Name:

Phone number? ( ) -  or Email address:   


 Who is helping you at home?

Last Name:   First Name:

Phone number? ( ) -   or Email address:


Do you belong to a synagogue? Yes No. If yes...

Name of Synagogue:

Address:

City:    State:    Zip:

Last Name of Rabbi:    First Name of Rabbi:

Phone number? ( ) -   or Email address:

Will there be a rabbi attending the event? Yes No

Are you affiliated? Yes No

If yes:



FINALLY (and these are the ONLY compulsory questions):


I have read and understand the Risks, Benefits and Alternatives to performing a Brit Milah/circumcision.
I affirm that all of the information above is accurate and true.

Please type the word 'bris' in the box below to prove that you are a human being.
(It helps prevent automated spammers.) Thank you.