New Member Application - Form - Brooklyn Heights Synagogue

Welcome to the Brooklyn Heights Synagogue. We are delighted that you have chosen to become part of our community. We hope that you will find membership an enriching experience and encourage you to explore the diverse opportunities for Jewish expression that BHS offers. Please call upon our clergy, staff, and lay leaders whenever we can assist you in becoming part of our community. All information in this application will be treated confidentially.

CONTACT INFORMATION

* Address

* City

* State

* Zip Code

How would you like your Name(s) to appear on mailings?

Our family wants to save trees, please email all correspondence!

Application Date

ADULT 1 INFORMATION

* Adult 1 - First Name

Adult 1 -Middle Name

* Adult 1 - Last Name

Adult 1 - Nickname

if applicable

* Adult 1 - Personal Status

Adult 1 - Anniversary Date

if applicable

Adult 1 - Hebrew Name

* Adult 1 - Mobile Phone

* Adult 1 - Date of Birth

* Adult 1 - Birthplace

* Adult 1 - Email address

I do not use email. Please mail all correspondence.

Adult 1 - Are you new to the Brooklyn Heights area?

Adult 1 - If so, what is your former City and State of Residence?

Adult 1 - Do you or any member of your family require special accommodations? If yes, please explain:

ADULT 1 EMERGENCY CONTACT

* Adult 1 - Emergency Contact Name

* Adult 1 - Emergency Contact Phone

* Adult 1 - Emergency Contact Relationship

* Adult 1 - Emergency Contact Address

* Adult 1 - Dr. Name

* Adult 1 - Dr. Phone

* Adult 1 - Health Care Proxy

ADULT 1 RELIGIOUS BACKGROUND

Adult 1 - Religious Identity

Adult 1 - If you became Jewish as an adult Date, Congregation, City

Adult 1 - Bar/Bat Mitzvah (if applicable) Date, Congregation, City

Adult 1 - Confirmation (if applicable) Date, Congregation, City

Adult 1 - Have you ever been a member of another synagogue (as an adult)? If so, when?

Adult 1 - Congregation most recently or currently affiliated with. Name, City, State and years.

Adult 1 - Please list any relatives or friends who are BHS members.

ADULT 1 BUSINESS INFORMATION

* Adult 1 - Occupation/Title

* Adult 1 - Area of specialization (Example: if law, what area? If medical, what field?)

* Adult 1 - Employer

* Adult 1 - Business Phone

* Adult 1 - Employer Address

ADULT 1 OPPORTUNITIES FOR PARTICIPATION

At the Brooklyn Heights Synagogue, we encourage our congregants to become involved in many aspects of life in our congregational community. In furthering this ideal, we request that upon signing this application you commit to participate in congregational life. Please indicate which of these areas interest you by checking the appropriate box or boxes. Your participation will help strengthen the community and will make your BHS experience more meaningful.

Choir/BandHoliday CelebrationsIsrael EngagementMembership Programs & Activities

Tell us more! What are your passions? What are your interests? How do you see yourself and your family becoming engaged in Synagogue life? Would you like to start a new committee or program? If so, please contact office@bhsbrooklyn.org

SECOND ADULT OPPORTUNITY

* Is there a second Adult applying for Membership?

ADULT 2 INFORMATION

* Adult 2 - First Name

Adult 2 -Middle Name

* Adult 2 - Last Name

Adult 2 - Nickname

if applicable

* Adult 2 - Personal Status

Adult 2 - Anniversary Date

if applicable

Adult 2 - Hebrew Name

* Adult 2 - Mobile Phone

* Adult 2 - Date of Birth

* Adult 2 - Birthplace

* Adult 2 - Email address

I do not use email. Please mail all correspondence.

Adult 2 - Are you new to the Brooklyn Heights area?

Adult 2 - If so, what is your former City and State of Residence?

Adult 2 - Do you or any member of your family require special accommodations? If yes, please explain:

ADULT 2 EMERGENCY CONTACT

* Adult 2 - Emergency Contact Name

* Adult 2 - Emergency Contact Phone

* Adult 2 - Emergency Contact Relationship

* Adult 2 - Emergency Contact Address

* Adult 2 - Dr. Name

* Adult 2 - Dr. Phone

* Adult 2 - Health Care Proxy

ADULT 2 RELIGIOUS BACKGROUND

Adult 2 - Religious Identity

Adult 2 - If you became Jewish as an adult Date, Congregation, City

Adult 2 - Bar/Bat Mitzvah (if applicable) Date, Congregation, City

Adult 2 - Confirmation (if applicable) Date, Congregation, City

Adult 2 - Have you ever been a member of another synagogue (as an adult)? If so, when?

Adult 2 - Congregation most recently or currently affiliated with. Name, City, State and years.

Adult 2 - Please list any relatives or friends who are BHS members.

ADULT 2 BUSINESS INFORMATION

* Adult 2 - Occupation/Title

* Adult 2 - Area of specialization (Example: if law, what area? If medical, what field?)

* Adult 2 - Employer

* Adult 2 - Business Phone

* Adult 2 - Employer Address

ADULT 2 OPPORTUNITIES FOR PARTICIPATION

Adult Education ClassesBook Group and Arts EventsChesed Caring/Social ActionFund Raising Events and Programs

Participating in Band or ChoirHoliday CelebrationsIsrael EngagementMembership Programs & Activities

MEMBERSHIP AUTHORIZATION

* Adult 1 - I am applying to become a member of Brooklyn Heights.

Adult 1 - I am applying to become a member of Brooklyn Heights.

* Adult 1 - Full Name

* Adult 1 - Date

* Adult 2 - I am applying to become a member of Brooklyn Heights.

Adult 2 - I am applying to become a member of Brooklyn Heights.

* Adult 2 - Full Name

* Adult 2 - Date

* English Name

Hebrew Name

if known

Relationship to Member

* English Date of Death

Before or After Sundown:

Remembered by:

* First and Middle Name

* Last Name

Gender

Hebrew Name

if known

* Birthdate

* Address

if not living with you

Marital Staus

* Is the child being raised in the Jewish Faith?

* Will this child be attending Religious School at BHS?

Bar/Bat Mitzvah Date, Congregation, City:

Confirmation Date, Congregation, City:

If previously attended Religious School, list Congregation, City:

Name of secular school, school address and grade