Membership Application - Form

Temple Chaverim Membership Application

How many adults are in your household?

PERSONAL INFORMATION

Member 1: Last name

Member 2: Last name

Member 1: First name

Member 2: First name

Member 1: Date of birth

Member 2: Date of birth

Member 1: Place of birth

Member 2: Place of birth

Member 1: Marital status

Member 2: Marital status

Member 1: Email address

Member 2: Email address

* Member 1: Occupation/Title

Member 2: Occupation/Title

Employer (Company or Business Name)

Member 1: Work phone

Member 2: Work phone

Member 1: Cell phone

Member 2: Cell phone

Member 1: Religion

Member 2: Religion

* Member 1: Religious affiliation

* Member 2: Religious affiliation

Member 1: Hebrew name

Please include your name, your father's name & your mother's name
Example: Isaac ben Abraham v'Sarah (ben = son of, bat = daughter of; v = and)

Member 2: Hebrew name

Please include your name, your father's name & your mother's name
Example: Isaac ben Abraham v'Sarah (ben = son of, bat = daughter of; v = and)

Member 1: Bar/Bat Mitzvah date

Member 2: Bar/Bat Mitzvah date

Date of marriage (if applicable)

Member 1: Special accommodations needed

Visual Impairment (large print prayerbook)Auditory Impairment (assisted hearing device)Physically ChallengedOther

Member 2: Special accommodations needed

Visual Impairment (large print prayerbook)Auditory impairment (assisted hearing device)Physically ChallengedOther

How would you like your name(s) to appear on Temple Mailings?

We will do our best to accommodate your request within system capabilities.

Referred By

Please list only one

Relatives at Temple Chaverim

ADDRESS

All mail will be sent to your residence unless otherwise requested.

Address Line 1

Address LIne 2

City

State

Zip Code

Home phone number

Mailing address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

FAMILY INFORMATION

Number of children:

* Applies to each of your children who reside with you.

1st Child

2nd Child

3rd Child

4th Child

Child 1: Last name

Child 2: Last name

Child 3: Last name

Child 4: Last name

Child 1: First name

Child 2: First name

Child 3: First name

Child 4: First name

Child 1: Birth date

Child 2: Birth date

Child 3: Birth date

Child 4: Birth date

Child 1: Gender

Child 2: Gender

Child 3: Gender

Child 4: Gender

Child 1: School grade Fall 2024

Child 2: School grade Fall 2024

Child 3: School grade Fall 2024

Child 4: School grade Fall 2024

Child 1: School Name

Child 2: School Name

Child 3: School Name

Child 4: School Name

Child 1: Hebrew name

Child 2: Hebrew name

Child 3: Hebrew name

Child 4: Hebrew name

Adult children who do NOT reside with you

Emergency Contact Information

Please enter at least one emergency contact.
Please include name and phone number.

YAHRZEIT INFORMATION

Please enter the number of people for whom you wish to observe yahrtzeit (memorial)

* A Yahrzeit reminder notice will be sent to you every year.

Please list the names of loved ones for whom you wish Yahrzeit notices sent

(1) Name of deceased and relationship to mourner

Mourner

Please enter name of person observing this Yahrzeit.

(1) Date of death

(1) Time of death

Before sunsetAfter sunset

(1) I'd like to observe the

English-DateHebrew Date

(2) Name of deceased and relationship to mourner

Mourner

Please enter name of person observing this Yahrzeit.

(2) Date of death

(2) Time of death

Before sunsetHebrew Date

(2) I'd like to observe the

English-DateHebrew Date

(3) Name of deceased and relationship to mourner

Mourner

Please enter name of person observing this Yahrzeit.

(3) Date of death

(3) Time of death

Before sunsetAfter sunset

(3) I'd like to observe the

English-DateHebrew Date

(4) Name of deceased and relationship to mourner

Mourmer

Please enter name of person observing this Yahrzeit.

(4) Date of death

(4) Time of death

Before sunsetAfter sunset

(4) I'd like to observe the

English-DateHebrew Date

(5) Name of deceased and relationship to mourner

Mourner

Please enter name of person observing this Yahrzeit.

(5) Date of death

(5) Time of death

Before sunsetAfter sunset

(5) I'd like to observe the

English-DateHebrew Date

(6) Name of deceased and relationship to mourner

Mourner

Please enter name of person observing this Yahrzeit.

(6) Date of death

(6) Time of death

Before sunsetAfter sunset

(6) I'd like to observe the

English-DateHebrew Date

Comments

TEXT MESSAGE NOTIFICATIONS

We now have a new way to communicate with you and keep you updated about important information via text messaging.

Just text 855-923-3186 and put chaverim in the message section, press send and you're in.
You can opt out at any time.

You're ALMOST done! Just a few more questions.....

Opportunity for Engagement in our Community

At Temple Chaverim, we believe that joining a congregation is a spiritual and emotional commitment.
We encourage all congregants to become involved in all aspects of life in our congregational
community. In furthering this ideal, we request that upon signing this application you commit to
participate in congregational life. Please indicate which of these areas interest you by checking the
appropriate box or boxes. Your participation will help strengthen the community and will make your
temple experience more meaningful. You will be contacted by a congregation member with more
information.

Member 1: If other, please specify:

Member 2: If other, please specify:

Upon completion of this Membership Application, you will be prompted to create an account.
After creating your account, please add your child(ren) using the "My Family" tile.
You will then be able to register for Religious School.

* Deposit - Please select one

Young Families Only (children have not yet entered 3rd grade as of Fall 2024) - $100All Others - $500A refundable deposit is due with this form.

Deposit Amount Due with this application

Applicant Signature

Applicant #1 - Signature

Applicant #2 - Signature