Membership Application

Thank you for your interest in KI. We are excited for you to join our KI family. Please tell us a little about you (and your family.)

Adult Members

Adult 1

* First Name

* Last Name

Middle Name

Tile (Mr., Ms., Dr., Rabbi, etc)

Birthday

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

* Email

* Preferred Phone Number

Street Address

City

State

Zipcode

Please explain:

Are you a:

KohenLeviYisraelUnknown

Are you an interfaith family? (KI welcomes interfaith families, and we are happy to have you join us. We also have resources for those looking to convert and/or learn more.)

NoYes

Tell us more about your Jewish Journey:

Bar/Bat Mitzvah Date

Bar/Bat Mitzvah Location

Wedding Date

Conversion Date

Adult 2

First Name

Last Name

Middle Name

Tile (Mr., Ms., Dr., Rabbi, etc)

Birthday

Hebrew Name

Father's Hebrew Name

Mother's Hebrew Name

Preferred Phone Number

Please explain:

Are you a:

KohenLeviYisraelUnknown

Do you have any children?

Children

Number of Children?

Child 1

First Name

Last Name

Middle Name

Gender

Birthday

Hebrew Name

Grade

School/College

Allergies?

Child 2

First Name

Last Name

Middle Name

Gender

Birthday

Hebrew Name

Grade

School/College

Allergies?

Child 3

First Name

Last Name

Middle Name

Gender

Birthday

Hebrew Name

Grade

School/College

Allergies?

Child 4

First Name

Last Name

Middle Name

Gender

Birthday

Hebrew Name

Grade

School/College

Allergies?

Child 5

First Name

Last Name

Middle Name

Gender

Birthday

Hebrew Name

Grade

School/College

Allergies?

I would like to enroll my child(ren) in:

PreschoolKIRS

Yahrzeit Information: Jewish custom calls for observing the anniversary of the death of family members according to the Jewish calendar. If applicable, please enter Yahrzeit information here so we can remind you of Yahrzeit dates.

Please enter the Yahrzeit information below. Please provide the Jewish and/or English day, month and year including whether it was daytime or evening. In addition please provide (if you know them) the deceased’s Hebrew name and parents' Hebrew names.

Other Information

Are there any other dates you would like to make us aware of? Anniversaries? Bar/Bat Mitzvah dates? Other milestones?

Is there any additional information you would like us to know about your family? (i.e. illness, special needs, skills/talents to share)

What do you want to gain from being a member of the KI community?

Are you interested in volunteer (shomrim, chesed, holidays) opportunities?

Please let us know if you have any skills such as reading torah, reading haftarah, leading services, etc, and you’re interested in participating during services. Or if you are interested in learning opportunities, please let us know.

Why did you select KI?

Do any of your family members have accessibility needs or accommodation requests that we should be aware of?

* I/We agree that KI may use photographs in electronic or print form in which my/our family may appear for publicity purposes.

Please Select OneYesNo

Join KI

Membership Application

Adult Members

Children

Other Information