New member application form

Please, enter your information

Spouse information will be entered below (if applicable)

Name*

Prefix First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth

Hebrew Birth Month

Hebrew Birth Day

Cell Phone Number

Home phone

(Hebrew Name) BEN/BAT (Father's Hebrew Name)

Tribe (males only)

Kohen

Levi

Yisrael

Bar Mitzvah Parsha (males only)

Involvement in Religious Services (For Primary Male Applicant, if applicable)

If you are male and capable, please indicate willingness to do any of the following:

Read from the Torah

Lead services

Give a D’var Torah

Present a shiur or lecture

General Volunteer Interests

Please indicate any areas where you (or a family member) might be willing to volunteer:

 Event planning or logistics

Youth or family programming

Marketing, design, or social media

 Fundraising or development

Building maintenance or setup

 Technology or IT support

Help with kiddush

Other:

Other Interests

Wedding Anniversary

Hebrew Wedding Anniversary Month

Hebrew Wedding Anniversary Day

Spouse Information:

Not Applicable

Spouse Name

Prefix First Last

Spouse Date of Birth

Spouse Hebrew Birth Month

Spouse Hebrew Birth Day

Spouse Cell Phone Number

Spouse Home Phone (if different)

Spouse Email

Spouse (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Spouse Tribe (males only)

Kohen

Levi

Yisrael

Spouse Bar Mitzva Parsha (males only)

Children Living In Your Home

Child 1

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Hebrew Birth Month

Child's Hebrew Birth Day

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 2

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Month

Child's Hebrew Birth Day

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 3

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Month

Child's Hebrew Birth Day

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 4

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Month

Child's Hebrew Birth Day

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 5

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Month

Child's Hebrew Birth Day

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 6

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Day

Child's Hebrew Birth Month

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 7

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Day

Child's Hebrew Birth Month

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Child 8

Child's Name

First Last (if different)

Child's Gender

Male

Female

Child's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Child's Bar Mitzva Parsha (males only)

Child's Date of Birth

Child's Hebrew Birth Day

Child's Hebrew Birth Month

Child's Email (if over 13)

Child's Cell Phone Number (if over 13)

Child's School

Other School

Child's Current Grade

Please share any of your child's hobbies, strengths, and interests.

Yahrtzeit List

You can add additional entries by clicking the plus sign to the right.

Departed's English Name

Departed's (Hebrew Name) BEN/BAT (Father's Hebrew Name)

Yahrtzeit Observed By:

Departed's Relation to Observer

English Date of Death

Hebrew Date of Death

Hidden

Section Break

Mi Shebairach List (if applicable)

Please enter the names of individuals you wish to make a mi shebairach for when you get an aliyah. Add additional entries by clicking the plus sign to the right. If you entered Hebrew names for immediate family members above, they will automatically be included. This field is for anyone you did not include above.

(Hebrew Name) BEN/BAT (Father's Hebrew Name)

English Name (First and Last)

Relation

Any other information we should know about?

By submitting this application, I/we affirm that all information provided is accurate and complete to the best of my/our knowledge.
I/we understand that this application is subject to review and approval by the Membership Committee and the Board of Congregation B’nai Israel-Ohev Zedek.
I/we agree to participate in a meeting with the Rabbi as part of the membership process.

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