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Congregant Information Form

All the information you provide will remain confidential.

We periodically produce directories with this information. Please contact us if you would prefer not to appear in the directory.

Adult #1

Adult #1 - Name(Required)

Adult #1 - Date of Birth(Required)

Adult #1 - Email(Required)

Adult #1 - Home Phone

Adult #1 - Cell Phone(Required)

Adult #1 - Address(Required)

Street Address Address Line 2 City State ZIP Code

Do you have a different mailing or billing address?

Different mailing address

Different billing address

Adult #1 - Mailing Address

Street Address Address Line 2 City State ZIP Code

Adult #1 - Billing Address

Street Address Address Line 2 City State ZIP Code

Adult #1 - Occupation (or n/a)(Required)

Adult #1 - Job Title

Adult #1 - Current Employer

Adult #1 - Employer Address

Street Address Address Line 2 City State ZIP Code

Adult #1 - Work Phone

Adult #1 - Work Email

Adult #1 - Marital Status

Single

Married

Widowed

Divorced

Domestic Partner

Adult #1 - Date of Marriage

Adult #1 - Relationship to any present member?

Adult #1 - Are you, or were you, a member of any other Congregation?(Required)

Yes

No

Adult #1 - Which one?

Adult #1 - Hebrew Name

Would you like to be contacted regarding choosing a Hebrew name?

Yes

No

Adult #1 - Jewish Background:

Reform

Conservative

Orthodox

Non-Jewish

Other

Adult #1 - If raised in another faith tradition, have you converted?

Yes

No

Adult #2

Adult #2 - Name

Adult #2 - Date of Birth

Adult #2 - Email

Adult #2 - Home Phone

Adult #2 - Cell Phone

Adult #2 - Address

Street Address Address Line 2 City State ZIP Code

Adult #2 - Occupation

Adult #2 - Job Title

Adult #2 - Current Employer

Adult #2 - Employer Address

Street Address Address Line 2 City State ZIP Code

Adult #2 - Work Phone

Adult #2 - Work Email

Adult #2 - Marital Status

Single

Married

Widowed

Divorced

Domestic Partner

Adult #2 - Date of Marriage

Adult #2 - Relationship to any present member?

Adult #2 - Are you, or were you, a member of any other Congregation?

Yes

No

Adult #2 - Which one?

Adult #2 - Hebrew Name

Adult #2 - Would you like to be contacted regarding choosing a Hebrew name?

Yes

No

Adult #2 - Jewish Background:

Reform

Conservative

Orthodox

Non-Jewish

Other

Adult #2 - If raised in another faith tradition, have you converted?

Yes

No

Reason(s) for Joining the Temple

What do you hope to gain from membership?

Child Information

Children

Click the plus (+) sign button on the right to add additional names.

Name

Nickname

Hebrew Name

Birthday

Gender

Yahrzeits

We remember the deceased loved ones of congregants on the anniversary of their death at our Friday night Shabbat services. Please list the names of loved ones you would like us to remember.

Yahrzeit Record

Click the plus (+) sign button on the right to add additional names.

Name of Deceased (First, Middle, Last)

Relationship

English Date of Death

Before/After Sunset

Do you want them remembered on the English anniversary or the Hebrew anniversary?

English anniversary

Hebrew anniversary

Cemetery

Do you have a cemetery plot?

Yes

No

If so, where?

Hobbies & Special Interests

(e.g., musical instruments, performing arts, outdoor activities, sports, etc.)

Adult #1 - Hobbies & Special Interests

Adult #2 - Hobbies & Special Interests

Affiliates/Committees

Our congregation is built on professional and lay partnership. May we contact you about volunteering?

Yes

No

Adult #1 - In what areas of synagogue life are you interested? What skills/talents/interests would you like to use to help the congregation?

Adult #2 - In what areas of synagogue life are you interested? What skills/talents/interests would you like to use to help the congregation?

Emergency Information

Emergency Contact Name(Required)

Emergency Contact Cell Phone(Required)

Emergency Contact Address

Street Address Address Line 2 City State ZIP Code

Additional Information

Comments/Message

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Congregation Emanu-El of Westchester
2125 Westchester Avenue East, Rye, NY 10580|914-967-4382