Membership Form - Form - Beth Sholom Congregation

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* E-mail Address

Personal Information
All information will be kept confidential.

Adult #1 - Title

* Adult #1 - First Name

* Adult #1 - Last Name

Adult #1 - Informal Name (nickname)

Adult #1 - E-mail Address

Adult #1 - Cell Phone Number

Adult #2 - Title

Adult #2 - First Name

Adult #2 - Last Name

Adult #2 - Informal Name (nickname)

Adult #2 - E-mail Address

Adult #2 - Cell Phone Number

* Home Address - Street

City

State

Zip Code

* Home Phone Number

Home Fax Number

* Emergency Contact #1 - First and Last Name

Emergency Contact - Best Contact Number

* Emergency Contact #2 - First and Last Name

Emergency Contact - Best Contact Number

Adult #1 - Date of Birth

Adult #1 - Gender

MaleFemaleNon-Binary

Adult # 2 - Date of Birth

Adult #2 - Gender

MaleFemaleNon-Binary

Marital Status

SingleMarriedWidowedPartneredSeparatedEngagedDivorced

Date of Marriage (if applicable)

Relationship

Are you related to another Beth Sholom member?

If applicable, how are you related to another Beth Sholom member?

Religious Tradition

Adult #1 - Are you:

Jewish at BirthJew by ChoiceNot Jewish

Adult #2 - Are you:

Jewish at BirthJew by ChoiceNot Jewish

Adult #1 - If Jewish, in which tradition were you raised?

ConservativeReformSecularOrthodoxReconstructionist

Adult #2 - If Jewish, in which tradition were you raised?

ConservativeReformSecularOrthodoxReconstructionist

Other:

Other

Adult #1 - Tribe

KohenLeviteIsraelite

Adult #2 - Tribe

KohenLeviteIsraelite

Adult #1 - Hebrew Name (use English Lettering) and include Hebrew/English Names of your Parents

Adult #2 - Hebrew Name (use English Lettering) and include Hebrew/English Names of your Parents

Adult #1 - Bar/Bat Mitzvah Date

Adult #2 - Bar/Bat Mitzvah Date

Adult #1 - Confirmation Date

Adult #2 - Confirmation Date

Adult #1 - If applicable, Hebrew Day School

Adult #2 - If applicable, Hebrew Day School

Adult #1 - Do you read Hebrew?

Adult #2 - Do you read Hebrew?

Adult #1 - Would you lead services?

Adult #2 - Would you lead services?

Adult #1 - Would you be willing to lead a Hebrew portion during services?

Adult #2 - Would you be willing to lead a Hebrew portion during services?

Adult #1 - Would you be willing to lead an English portion during services?

Adult #2 - Would you be willing to lead an English portion during services?

Adult #1 - Do you chant from the Torah?

YesNo

Adult #1 - Do you chant from the Haftorah?

YesNo

Adult #2 - Do you chant from the Torah?

YesNo

Adult #2 - Do you chant from the Haftorah?

YesNo

Employment Information

Adult #1 - Occupation

Adult #2 - Occupation

Children Information

Child #1 - First Name

Child #1 - Last Name

Child #1 - Hebrew Name (use English Lettering)

Child #1 - Gender

MaleFemaleNon-Binary

Child #1 - Date of Birth

Child #1 - Bar/Bat Mitzvah Date

Child #1 - Secular School and Grade

Child #2 - First Name

Child #2 - Last Name

Child #2 - Hebrew Name (use English Lettering)

Child #2 - Gender

MaleFemaleNon-Binary

Child #2 - Date of Birth

Child #2 - Bar/Bat Mitzvah Date

Child #2 - Secular School and Grade

Child #3 - First Name

Child #3 - Last Name

Child #3 - Hebrew Name (use English Lettering)

Child #3 - Gender

MaleFemaleNon-Binary

Child #3 - Date of Birth

Child #3 - Bar/Bat Mitzvah Date

Child #3 - Secular School and Grade

Child's Address if different from Adult #1 or Adult #2

Yahrzeit Information

First and Last Name

Relationship

Date of Passing

First and Last Name

Relationship

Date of Passing

First and Last Name

Relationship

Date of Passing

Physical Restrictions

Do you or any member of your family have any acute medical conditions you would like the rabbi to be aware of?

Adult #1 - Physical Restrictions

VisionHearingMobility

Adult #2 - Physical Restrictions

VisionHearingMobility

Sun, April 20 2025 22 Nisan 5785

Office: (215) 887-1342
School: (215) 887-3625
Fax: (215) 887-6605

8231 Old York Road
Elkins Park, PA 19027

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