2025-2026 Membership Form - Form - Temple Israel of Westport

MEMBERSHIP FORM

* Type of Household

ADULT MEMBER ONE

* First Name

* Last Name

* Birth Date

* Pronouns

What should we call you?

* Cell Phone

* Email

Religious Upbringing

Hebrew Name

Occupation

Company

Business Address

City

State

Zip

DEMOGRAPHIC INFORMATION

ADULT MEMBER TWO

* First Name

* Last Name

* Birth Date

* Pronouns

What should we call you?

* Cell Phone

* Email

Religious Upbringing

Hebrew Name

Occupation

Company

Business Address

City

State

Zip

DEMOGRAPHIC INFORMATION

MAILING & MEMBERSHIP INFORMATION

* Home Address

* City

* State

* Zip

Home Phone

Marital Status

Anniversary (if applicable)

EMERGENCY CONTACT

Local Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

Have you ever attended services at TI?

Do you have any relatives who belong to TI?

What are their names?

FAMILY INFORMATION

Please list all children under age 22

How many children?

CHILD ONE

* First Name

* Last Name

Hebrew Name

* Pronouns

* Birthday

* Grade

* High School Graduation Year

* Does this child live with you?

Please Select OneYesNo

* Are you enrolling this child in Kesher?

Please Select OneYesNo

* Are you enrolling this child in the Early Childhood Center?

Please Select OneYesNo

CHILD TWO

* First Name

* Last Name

Hebrew Name

* Pronouns

* Birthday

* Grade

* High School Graduation Year

* Does this child live with you?

Please Select OneYesNo

* Are you enrolling this child in Kesher?

Please Select OneYesNo

* Are you enrolling this child in the Early Childhood Center?

Please Select OneYesNo

CHILD THREE

* First Name

Last Name

Hebrew Name

* Pronouns

* Birthday

* Grade

* High School Graduation Year

* Does this child live with you?

Please Select OneYesNo

* Are you enrolling this child in Kesher?

Please Select OneYesNo

* Are you enrolling this child in the Early Childhood Center?

Please Select OneYesNo

CHILD FOUR

* First Name

* Last Name

Hebrew Name

* Pronouns

* Birthday

* Grade

* High School Graduation Year

* Does this child live with you?

Please Select OneYesNo

* Are you enrolling this child in Kesher?

Please Select OneYesNo

* Are you enrolling this child in the Early Childhood Center?

Please Select OneYesNo

CHILD FIVE

* First Name

* Last Name

Hebrew Name

* Pronouns

* Birthday

* Grade

* High School Graduation Year

* Does this child live with you?

Please Select OneYesNo

* Are you enrolling this child in Kesher?

Please Select OneYesNo

* Are you enrolling this child in the Early Childhood Center?

Please Select OneYesNo

Do you have a child/children in college?

List their name(s), college(s), and graduation year(s)

YAHRZEITS

Please list the names of loved ones who have died, for whom you observe Yahrzeit. Kaddish will be recited at Shabbat services closest to the anniversary date. Note: Temple Israel defaults to observing the English date for yahrzeits. If you prefer to observe the Hebrew Date, please check this box.

How many yahrzeits?

YAHRZEIT ONE

Full Name

Hebrew Name

Related to:

Relationship

Date

Hebrew Date

YAHRZEIT TWO

Full Name

Hebrew Name

Related to:

Relationship

Date

Hebrew Date

YAHRZEIT THREE

Full Name

Hebrew Name

Relationship

Related to:

Date

Hebrew Date

YAHRZEIT FOUR

Full Name

Hebrew Name

Relationship

Related to:

Date

Hebrew Date

YAHRZEIT FIVE

Full Name

Hebrew Name

Relationship

Related to:

Date

Hebrew Date

PHOTO RELEASE

* I/We, the undersigned, agree to grant Temple Israel permission to photograph or film my/our participation at Temple Israel events. I/We further agree that any or all of the material photographed may be used, in any form, as part of any publications or social media posts to promote Temple Israel.

I/We, the undersigned, agree to grant Temple Israel permission to photograph or film my/our participation at Temple Israel events. I/We further agree that any or all of the material photographed may be used, in any form, as part of any publications or social media posts to promote Temple Israel.

FINANCIAL AGREEMENT

* I/We, the undersigned, hereby make application for Temple Israel membership. I/We agree to abide by its rules and by-laws. I/We understand that membership is on a yearly basis, payable in advance, not transferable and that dues are not refundable.

I/We, the undersigned, hereby make application for Temple Israel membership. I/We agree to abide by its rules and by-laws. I/We understand that membership is on a yearly basis, payable in advance, not transferable and that dues are not refundable.