Mezuzah Bank - CKIDS JEWQ

Child's Name*

First Name

Last Name

Hebrew Name

Chabad Rabbi or Rebbetzin Name *

Chabad Rabbi or Rebbetzin Email *

Chabad Affiliate Name*

Did you take 3 JewQ tests?

Yes No

For JewQ Champions

Did you do 100 missions in Tzivos Hashem?

Yes No

For Tzivos Hashem Members

Parent's Email*

Do you have a Kosher Mezuzah on the doorpost of your bedroom?*

Yes, (if yes, you should gift your Mezuzah from the Mezuzah Bank to a Jewish friend who does not have a Mezuzah on their bedroom doorpost) No

Note: A Kosher Mezuzah is not the case. It's a scroll of real Kosher parchment with the first 2 parts of the Shema, carefully written by hand by an expert scribe, placed inside a case. If you aren't sure if your Mezuzah is Kosher, please ask your Chabad Rabbi

Name of the friend that you will gift the Mezuzah to?*

What does the Mezuzah mean to you?**

I agree to send a picture of the Mezuzah properly affixed to my doorpost (or my friend's doorpost) within 2 weeks of receiving it*

Yes No