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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
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
Relationship Status
Single
Married
Divorced
Widowed
Partnered
Other
Please explain:
In what religious tradition were you raised?
Orthodox
Conservative
Reform
Reconstructionist
Unafiliated
Not Jewish
Other
Are you a:
Kohen
Levi
Yisrael
Unknown
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.)
No
Yes
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
Email
Preferred Phone Number
Relationship Status
Single
Married
Divorced
Widowed
Partnered
Other
Please explain:
In what religious tradition were you raised?
Orthodox
Conservative
Reform
Reconstructionist
Unafiliated
Not Jewish
Other
Are you a:
Kohen
Levi
Yisrael
Unknown
Do you have any children?
No
Yes
Children
Number of Children?
1
2
3
4
5
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:
Preschool
KIRS
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 One
Yes
No
Wed, December 4 2024
3 Kislev 5785
Wed, December 4 2024 3 Kislev 5785