Membership Application

Shalom/Welcome to Temple Chaverim – a temple of friends, dedicated to building Jewish lives, homes and community through spiritual, educational and communal engagement.

We are delighted you have chosen to join Temple Chaverim, a Reform congregation and member of the Union for Reform Judaism. We hope that you will find many ways to become engaged in all that Temple Chaverim has to offer. Please call upon our clergy, staff, and lay leaders whenever we can assist you along the way. All information in this application will be treated confidentially. Please call our office at 516-367-6100 if you have any questions at all or need assistance in filling out this application. Thank you and welcome!

Personal Information

Adult Applicant #1 - Name*

Prefix First Last

Adult Applicant #2 - Name

Prefix First Last

Adult Applicant #1 - Gender*

Male
Female

Adult Applicant #2 - Gender

Male
Female

Adult Applicant #1 - By what first name to you wish to be addressed (if different from above)?

Adult Applicant #2 - By what first name to you wish to be addressed (if different from above)?

Adult Applicant #1 - Personal Status

Anniversary Date

Adult Applicant #1 - Date of Birth*

Adult Applicant #2 - Date of Birth

Adult Applicant #1 - Birthplace*

Adult Applicant #2 - Birthplace

Adult Applicant #1 - Former city and state of residence

Adult Applicant #2 - Former city and state of residence

Adult Applicant #1 - Hobbies, special interests or passions

Adult Applicant #2 - Hobbies, special interests or passions

Adult Applicant #1 - Blood Type

Adult Applicant #2 - Blood Type

Adult Applicant #1 - Special accomodations needed:

Visual impairment (large print prayer book)
Audity impairment (assisted hearing devices)
Physically challenged
Other

Adult Applicant #2 - Special accomodations needed:

Visual impairment (large print prayer book)
Audity impairment (assisted hearing devices)
Physically challenged
Other

Please describe the speical accomodations needed:

Family Relationships with other members

Please list names and relationship.

Contact Information

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

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

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Secondary Address (if different)

Street Address Address Line 2 City State ZIP Code

Secondary Home Phone

Adult Applicant #1 - Cell Phone*

Adult Applicant #2 - Cell Phone

Adult Applicant #1 - Email*

Adult Applicant #2 - Email

Adult Applicant #1 - Would you like to receive temple communications via email?

Yes
No

Adult Applicant #2 - Would you like to receive temple communications via email?

Yes
No

Would you prefer email statements?*

Yes
No

May we list your email address in a Temple Chaverim email directory?*

Yes
No

May photographs of your family members be used in Temple Chaverim publicity?*

Yes
No

Religious Background

Adult Applicant #1 - Religious background in which you were raised:

Adult Applicant #2 - Religious background in which you were raised:

If you became Jewish as an adult, please enter the Date, Congregation, and City

Adult Applicant #1	Adult Applicant #2

Bar/Bat Mitzvah (if applicable) Date, Congregation, City

Adult Applicant #1	Adult Applicant #2

Confirmation (if applicable) Date, Congregation, City

Adult Applicant #1	Adult Applicant #2

Congregation most recently or commonly affiliated with:

Adult Applicant #1	Adult Applicant #2

Business Information

Adult Applicant #1 - Occupation/Profession/Title

Adult Applicant #2 - Occupation/Profession/Title

Adult Applicant #1 - Area of Specialization

Adult Applicant #2 - Area of Specialization

Adult Applicant #1 - Employer (Company or Business Name)

Adult Applicant #2 - Employer (Company or Business Name)

Adult Applicant #1 - Business Address

Street Address Address Line 2 City State ZIP Code

Adult Applicant #2 - Business Address

Street Address Address Line 2 City State ZIP Code

Adult Applicant #1 - Business Phone

Adult Applicant #2 - Business Phone

Adult Applicant #1 - Business Email

Adult Applicant #2 - Business Email

Yahrzeit Information

Yahrzeits

(Note: For entry into the Temple database, you must include the full date of death).

Name	Family Relationship	Date of Death	Before/After Sunset?

Do you wish to recall these yahrzeits on the:

Hebrew date
English date

Please send information on memorial plaques:

Yes
No

Children's Information

Name	Male/Female	Hebrew Name (if known)	Date of Birth

Do children live with you?

Yes
No

Address of Child, if not living with you:

Street Address Address Line 2 City State ZIP Code

Children's Email Addresses

Child's Name	Email Address

Child's School (if applicable)

Child's Name	Name of School

Child #1 - Marital Status

Single
Married
Partnered

Child #2 - Marital Status

Single
Married
Partnered

Child #3 - Marital Status

Single
Married
Partnered

Child #4 - Marital Status

Single
Married
Partnered

Will any of these children be attending Religious School at Temple Chaverim?

Child's Name	Yes/No?

Childrens' Bar/Bat Mitzvah Information

Child's Name	Date	Congregation	City

Childrens' Confirmation Information

Child's Name	Date	Congregation	City

If previously attended Religious School:

Child's Name	Congregation	City

Emergency Contact Information

Emergency Contacts*

Please enter at least one (1) emergency contact.

Name	Relationship	Cell Phone	Work Phone

Health Care Emergency Information

Please enter at least one (1) emergency contact.

Adult Applicant	Dr. Name	Dr. Phone	Health Care Proxy Name	Health Care Proxy Pone

Additional Adults Living in Your Home

Additional Adults

Name	Male/Female	Relationship	Date of Birth	Marital Status

How did you hear about Temple Chaverim?

Who referred you?

Reasons for joining today:

Opportunity for Engagement in our Community

At Temple Chaveirm, 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.

Talent and Interest Survey

Applicant #1 - Signature*

I acknowledge that I am applying to become a member of Temple Chaverim and I agree to satisfy all aspects of my commitment to the Temple Chaverim Community as established by the Board of Trustees.

Applicant #2 - Signature

I acknowledge that I am applying to become a member of Temple Chaverim and I agree to satisfy all aspects of my commitment to the Temple Chaverim Community as established by the Board of Trustees.

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Membership Application

Personal Information

Contact Information

Religious Background

Business Information

Yahrzeit Information

Children's Information

Emergency Contact Information

Additional Adults Living in Your Home

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