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
- Single
- Married
- Partnered
- Separated
- Divorced
- Widowed
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.

Religious Background
Adult Applicant #1 - Religious background in which you were raised:
- Reform
- Conservative
- Orthodox
- Jewish unaffiliated
- Jewish by choice
- Non-practicing
- Other religious tradition
- I am interested in learning more about Judaism
Adult Applicant #2 - Religious background in which you were raised:
- Reform
- Conservative
- Orthodox
- Jewish unaffiliated
- Jewish by choice
- Non-practicing
- Other religious tradition
- I am interested in learning more about Judaism
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
Children's Information
Name Male/Female Hebrew Name (if known)
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?
- Referred by friends
- Have always known about Temple Chaverim
- Saw publicity in paper
- Website
- Other
Who referred you?
Reasons for joining today:
- Clergy
- Friend(s) is/are members
- Religious School
- Spiritual Growth
- Life Cycle
- Adult Learning Opportunities
- Social Justice
- Other
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.
- Adult Learning
- Assistance with office work
- Budget and Finance
- Bulleting Writing and Editing
- Communications and Publicity
- Couples Club
- Fundraising
- Holiday Celebrations and/or Decorations
- Library
- Maintenance and Building Repair
- Men's Club
- Music - Choir or Band
- Religious School Activities & Projects
- Sisterhood
- Visiting the Sick and Bereaved
- Youth Activities
Talent and Interest Survey
- Cooking
- Music
- Baking
- Plumbing
- Painting
- Gardening
- Electrical
- Public Relations
- Israeli Dancing
- Driving
- Carpentry
- Sewing/Needlework
- Art
- Travel
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

Step 1 of 7

Personal Information

Contact Information

Religious Background

Business Information

Yahrzeit Information

Children's Information

Emergency Contact Information

Additional Adults Living in Your Home

In This Section

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

Name	Family Relationship	Date of Death	Before/After Sunset?

Name	Male/Female	Hebrew Name (if known)

Child's Name	Email Address

Child's Name	Name of School