Kallah Registration
Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
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Personal Information
Wedding Date Set?
*
Yes
No
Wedding Date
/
Month
/
Day
Year
Date
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Officiating Rabbi
*
Who is your teacher?
*
Do you have another minute to answer some more optional personal questions?
*
Yes!
No
Personal Questions Survey (Optional)
Please fill out as many of the question below that you are comfortable answering. This information will help us match you to the most suitable Kallah Mentor for you.
If employed, occupation?
What are your current feelings about going to Mikveh after your wedding?
Planning on it
Undecided
Not interested
Have you ever been on a tour of a Mikveh?
Yes
No
What are you looking most forward to learning about?
Which Synagogue does your family currently attend, if any?
Is there anything that you particularly want to focus on during your sessions?
Have you or are you currently taking other classes about Marital Harmony and Couples Education?
Yes
No
Have you learned about Family Purity in any previous way (high school, post-high school, class, books, others)?
Anything else you would like to let us know about?
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