Schedule an Immersion

This form is to be used after you have confirmed a date and time with Mayyim Hayyim's Mikveh Manager. If you need assistance scheduling, please reach out to us at info@mayyimhayyim.org

Please fill out the form below to schedule an appointment at Mayyim Hayyim. If you are requesting an appointment for more than one person, please select "Add another response" at the bottom of the form; you must use a unique email for each adult.

Contact Information of Person Immersing

I am filling this form out on behalf of a child (under 18)

YesNo

First name

Last name

Date of Birth of person immersing

Gender

Pronouns

Parent/Guardian First Name if under 18

Parent/Guardian Last Name

Email of parent/guardian

Email of person immersing

Phone

Address

City

State

Postal Code

Country

Immersion Information

When would you like to immerse? Please enter the date and time that has been previously discussed with the Mikveh Manager:

First Choice Date and Time

Format: 8/1/2022 1:00pm; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

This is the only time I am available; no need to offer other optionsI have some flexibility and can offer other options

Second Choice Date and Time

Format: 8/1/2022 2:00pm; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

Third Choice Date and Time

Format: 8/2/2022 11:00am; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

Anything else you would like us to know about your availability?

Reason for Immersion

Other

Preferred gender (if any) of Mikveh Guide:

During your visit, a volunteer Mikveh Guide will always be present to welcome you and ensure your privacy. Traditionally, a Mikveh Guide acts as a witness to make certain that one’s entire body (including all hair) is immersed under water. Mikveh Guides hold a sheet above their eyes, only lowering it down at the moment of immersion. Mayyim Hayyim also trains Mikveh Guides to help facilitate the ritual, providing guidance and support when appropriate. However, you may choose to immerse in private or with a friend or family member acting as your witness.

Yes, I would like my Mikveh Guide to wear a face mask.

If you expect to bring any guests with you, please let us know about how many (up to 10) you expect to join:

Are there any access needs that we should be made aware of to ensure greatest ease, safety and comfort?

Is there anything else you'd like us to know to help make this experience as meaningful as possible?

How will you be paying for this immersion?

Please select the reason that most closely describes what prompted your decision to request this immersion

Contact Information