HERJC Membership Application - Hewlett E. Rockaway Jewish Center

Hewlett-East Rockaway Jewish CentreCongregation Etz Chaim295 Main Street, East Rockaway, NY 11518 • Tel 516.599.2634 • Fax 516.599.2851Email office@herjc.org • www.herjc.orgWELCOME TO HERJCWe are bound together by tradition, love of community and a commitment to sustaining a warm, caring and diverseJewish center for ourselves, our children and future generations. As a first step in getting to know you, we ask that youcomplete this informational form. Your answers help us understand how we can best serve you.(Information is for synagogue use only and will be kept confidential.)FAMILY INFORMATIONFamily Name(s) __________________________________________________________________________________________________Address_________________________________________________________________________________________________________City, State, Zip+4_________________________________________________________________________________________________Home Phone ____________________________________________Date___________________________________________________MY INFORMATIONMy Name_______________________________________________ Nickname ______________________________________________Hebrew Name___________________________________________ Tribe: q Kohen q Levi q Yisrael q Don’t Know q Not JewishBirthday ________________________________________________ Parent’s Hebrew Names __________________________________E-mail__________________________________________________ Cell Phone _____________________________________________What’s the best way to reach you: q Home q Phone q Cell Phone q EmailMarital Status: q Single q Widowed q Divorced q Married, Anniversary Date __________________________________________Occupation _____________________________________________________________________________________________________Employer _______________________________________________________________________________________________________Work Phone ____________________________________________________________________________________________________SPOUSE’S INFORMATIONSpouse’s Name __________________________________________ Nickname ______________________________________________Hebrew Name___________________________________________ Tribe: q Kohen q Levi q Yisrael q Don’t Know q Not JewishBirthday ________________________________________________ Parent’s Hebrew Names __________________________________E-mail__________________________________________________ Cell Phone _____________________________________________What’s the best way to reach you: q Home q Phone q Cell Phone q EmailMarital Status: q Single q Widowed q Divorced q Married, Anniversary Date __________________________________________Occupation _____________________________________________________________________________________________________Employer _______________________________________________________________________________________________________Work Phone ____________________________________________________________________________________________________

TELL US ABOUT YOUR CHILDRENSINGLE CHILDREN. If a child lives at another address (at school, with another parent) and you would like themto receive synagogue mail or email, please provide us with their address.FIRST & MIDDLE NAME SEX HEBREW NAME BIRTH SCHOOL & GRADE EMAIL ADDRESS(Last name, if different) M/F DATEWill your children attend our Religious School, Nursery Schools or Youth Group? To enroll, contact:Nursery School . . . Cheryl Karp – Early Childhood Director, 516-599-1169, nurserydir@herjc.orgReligious School . . . . David Woolfe – Religious School Director, 516-599-0424, rsdir@herjc.orgYouth Group . . . . . . . . . . . Todd Hausman – Youth Director, 516-599-1148, youthdir@herjc.orgMARRIED CHILDREN.MARRIED NAME & SPOUSE BIRTH DATE ADDRESS NAMES OF GRANDCHILDRENRELATIVESDo you have relatives who are HERJC members? Please list their name(s) and relationship(s) to you.––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––YAHRZEIT INFORMATIONLet us help you perform the mitzvah of remembrance. We will send you a letter about a month before your loved one’syahrzeit, informing you when to say Kaddish. These names are also listed in Hakol, our synagogue bulletin and may beread from the bimah the week of the yahrzeit.NAME RELATIONSHIP DATE OF DEATH SUNDOWNq Before q Afterq Before q Afterq Before q Afterq Before q Afterq Before q After