Membership & Household Profile Form - Form

Congregation Beth Am of Los Altos Hills, CA

Welcome to Congregation Beth Am! We are delighted you have chosen to become part of our community. We hope that you will find membership an enriching experience, and we encourage you to explore the diverse opportunities for Jewish expression that Congregation Beth Am offers. Please call upon our clergy, staff, and lay leaders whenever we can assist you in becoming part of our Congregation Beth Am family.

All information you submit on this form will be treated confidentially in accordance with our privacy policy. Please call our office at (650) 493-4661 if you have any questions or need assistance in filling out this application. We typically respond in 2-3 business days.

Please Note:

Completing this form will not give you instant access to our livestreaming or other member privileges.
Current Beth Am Members who need to reset their account's password should not fill out this form. Instead, please use this forgot my password link.

CONTACT INFORMATION

Please complete the Membership Form as completely as possible. Fields with an asterisk (*) are required. Many fields are optional with the intent to help us learn about you & your interests.

* Name of person completing this form:

I/We have lived in the area for:

Years

Months

I/We moved here from:

City

US State

or Country

SYNAGOGUE HISTORY

* Previous Synagogue Affiliation or Participation?

Name of Synagogue(s)

HOUSEHOLD PROFILE INFORMATION

* Home Address

Home Address 2nd Line (optional)

* City

* State

* Zip

ADULT 1

* Adult 1 - First Name

* Adult 1 - Last Name

Adult 1 - Nickname

(if applicable)

Adult 1 - Gender

* Adult 1 - Email

Adult 1 - Mobile Phone

Adult 1 - Hebrew Name (optional)

(optional to use Hebrew alphabet)

Adult 1 - Ben/Bat

Adult 1 - Fathers Hebrew Name

(optional to use Hebrew alphabet)

Adult 1 - Mothers Hebrew Name

(optional to use Hebrew alphabet)

* Adult 1 - Date of Birth

* Adult 1 - Birthplace

Adult 1 - Occupation

Adult 1 - Name of Employer

Adult 1 - Business Phone

Adult 1- LinkedIn public profile url link (optional)

example: www.linkedin.com/in/yourname

* Adult 1 - Religious background in which you were raised:

Adult 1 - Are you currently:

Adult 1 - Other religion

Adult 1 - My education included (Check all that apply):

Bar/Bat MitzvahConfirmationJewish CampIsrael Trip

Adult 1 - I currently (Check all that apply):

Read HebrewSpeak HebrewChant Torah/Haftarah

Adult 1 - I prefer to self-identify as:

* Relationship Status

Date of Marriage

--- form continues ---

Adult 2

* Adult 2 - First Name

* Adult 2 - Last Name

Adult 2 - Nickname

(if applicable)

Adult 2 - Gender

Adult 2 - Email

Adult 2 - Mobile Phone

Adult 2 - Hebrew Name (optional)

Adult 2 - Ben/Bat

Adult 2 - Fathers Hebrew Name

Adult 2 - Mothers Hebrew Name

Adult 2- Date of Birth

Adult 2 - Birthplace

Adult 2 - Occupation

Adult 2 - Name of Employer

Adult 2 - Business Phone

Adult 2- LinkedIn public profile url link (optional)

example: www.linkedin.com/in/yourname

* Adult 2 - Religious background in which you were raised:

Adult 2 - Are you currently:

Adult 2 - Other religion

Adult 2 - Did your education include (Please check all that apply)

Bar/Bat MitzvahConfirmationJewish CampIsrael Trip

Adult 2 - Do you currently (Please check all that apply)

Read HebrewSpeak HebrewChant Torah/Haftarah

Adult 2 - I prefer to self-identify as:

CHILD(REN) INFORMATION

How many children will be included in your household membership?

You may enter information for up to 4 children on this form. If you have 5+ children in your household, please contact the Beth Am Office at (650) 493-4661 to provide your children's information.

You may also enter your adult child(ren)'s information on this form for children ages 18-23. A separate membership is required for children aged 24+.

--- Form Continues ---

CHILD 1

Child 1 - Education Level

* Child 1 - Does the child belong to Beth Am

* Child 1 - First Name

Child 1 - Middle Name

* Child 1 - Last Name

Child 1 - Preferred Name

* Child 1 - Email

Child 1 - Hebrew Name

* Child 1 - Date of Birth

Child 1 - Current School

* Child 1 - Current Grade

* What religious education has Child #1 completed? (Check all that apply)

Bar/Bat Mitzvah

Bar/Bat Mitzvah Date

Confirmation

Confirmation Date

* Child 1 - City

* Child 1 - State

Child 1 - Is Child still a student?

Child 1 - School

Child 1 - Expected date of graduation

* Child 1 - Does the child have a spouse or partner?

Child 1 - Name of Partner

* Child 1 - Does the child have children?

Grandchild(ren) Name(s)

CHILD 2

* Child 2 - Education Level

* Child 2 - Does the child belong to Beth Am

Child 2 - First Name

Child 2 - Middle Name

Child 2 - Last Name

Child 2 - Preferred Name

* Child 2 - Email

Child 2 - Hebrew Name

* Child 2 - Date of Birth

Child 2 - Current School

Child 2 - Current Grade

* What religious education has Child #2 completed? (Check all that apply)

Bar/Bat Mitzvah

Bar/Bat Mitzvah Date

Confirmation

Confirmation Date

* Child 2 - City

* Child 2 - State

Child 2 - Is Child still a student?

Child 2 - School

Child 2 - Expected date of graduation

Child 2 - Does the child have a spouse or partner?

Child 2 - Name of Partner

* Child 2 - Does the child have children?

Grandchild(ren) Name(s)

CHILD 3

* Child 3 - Education Level

* Child 3 - Does the child belong to Beth Am

Child 3 - First Name

Child 3 - Middle Name

Child 3 - Last Name

Child 3 - Preferred Name

* Child 3 - Email

Child 3 - Hebrew Name

* Child 3 - Date of Birth

Child 3 - Current School

Child 3 - Current Grade

* What religious education has Child #3 completed? (Check all that apply)

Bar/Bat Mitzvah

Bar/Bat Mitzvah Date

Confirmation

Confirmation Date

* Child 3 - City

* Child 3 - State

Child 3 - Is Child still a student?

Child 3 - School

Child 3 - Expected date of graduation

Child 3 - Does the child have a spouse or partner?

Child 3 - Name of Partner

* Child 3 - Does the child have children?

Grandchild(ren) Name(s)

CHILD 4

Child 4 - Education Level

* Child 4 - Does the child belong to Beth Am

* Child 4 - First Name

Child 4 - Middle Name

* Child 4 - Last Name

Child 4 - Preferred Name

* Child 4 - Email

Child 4 - Hebrew Name

* Child 4 - Date of Birth

Child 4 - Current School

Child 4 - Current Grade

* What religious education has Child #4 completed? (Check all that apply)

Bar/Bat Mitzvah

Bar/Bat Mitzvah Date

Confirmation

Confirmation Date

* Child 4 - City

* Child 4 - State

Child 4 - Is Child still a student?

Child 4 - School

Child 4 - Expected date of graduation

Child 4 - Does the child have a spouse or partner?

Child 4 - Name of Partner

Child 4 - Does the child have children?

Grandchild(ren) Name(s)

REFERRAL INFORMATION

How did you hear about Congregation Beth Am?

Referred by:

Reason(s) for joining Congregation Beth Am (check all that apply)

Reason(s) for joining Congregation Beth Am (continued):

My Friends or Family BelongI/We Grew Up at Beth AmTo Become Active in a Jewish CommunityParticipate in Social Justice EffortsAttracted by Diversity of the CommunityAttracted to Interfaith Friendly CommunityAttracted to LGBTQIA+ Friendly Community

Other reason for joining:

BETH AM FRIENDS & RELATIVES

Please click the + button to add each friend or relative (not previously listed) who are already members of the Congregation Beth Am community and their relationship to you (e.g., "Helene Lewis, Andy's cousin")

Name

Relationship

describe how is this person related to your household
example: Andy's sister

YAHRZEIT INFORMATION

Yahrzeit Information (Anniversary of Death)

Regardless of their religious identity, if you have loved ones whose names you would like to be placed on our Kaddish list to be read allowed during Services on the yearly anniversary of their passing, please list their names below. It is your choice to observe Yahrzeit on the Hebrew calendar date of their death or on the English calendar date. Please let us know if you would like assistance in determining the Hebrew date. A Yahrzeit reminder will be sent prior to the memorial date.

Please click the + button to add each Yahrzeit you and/or your family observes.
Note: this information can also be submitted at a later time by contacting our office.

Deceased Full Name

Relationship to Adult 1

Relationship to Adult 2

English Date of Death

Observance - English/Hebrew calendar

Before/After Sunset

OTHER INFORMATION

Beth Am has many resources that may be helpful to you and your family. Please indicate any special needs requests for members of your household for which you would like the Congregation to be aware. Click the + button to add each individual, and let us know how we can be of assistance.

Is there anything else you would like to know about Congregation Beth Am?

EMERGENCY CONTACTS

Please click the + button to add each emergency contact.

Name

Phone Number

Relationship

PHOTO RELEASE

Release for use of likeness (photo release)

Adult 1 - Photo Release

Please Select OneYesNo

Adult 2 - Photo Release

Please Select OneYesNo

I hereby grant Congregation Beth Am permission to use my likeness in photographic or other form in any and all of its publications and all other media, controlled by Congregation Beth Am or its licensees, whether now known or hereafter existing. I hereby release Congregation Beth Am from any and all liability that may arise out of the use of my likeness. The releases and permissions above shall exist in perpetuity, throughout the universe.

Child - Photo Release

Please Select OneYesNo

I hereby grant Congregation Beth Am permission to use the likeness of my minor child(ren) in photographic or other form in any and all of its publications and all other media controlled by Congregation Beth Am or its licensees, whether now known or hereafter existing. I hereby release Congregation Beth Am from any and all liability that may arise out of the use of such likeness(es). I hereby represent that I am the parent and/or legal guardian of such child(ren). The releases and permissions above shall exist in perpetuity, throughout the universe.

MEMBER DIRECTORY LISTING

The Membership Directory is a helpful way to connect with other members of the congregation. It is for non-commercial use by members only and requires a Beth Am Member Account to access it.

Show or hide account in the member directory?

Please Select OneShowHide

Members can edit their membership directory listing information at any time from the Beth Am Member website and select what information is shown or hidden. Default account listing information includes adult names, photo (if submitted), address, phone number and email addresses, and children names.

ANNUAL COMMITMENT INFORMATION

We ask members to make an annual financial commitment commensurate with their individual giving ability.
No individual or family will be denied membership due to financial circumstances.

We are firmly committed to making membership available to everyone and do not want anyone to forgo membership solely for financial reasons. If you have a question about Membership, please contact our Executive Director at (650) 493-4661 for a confidential discussion.

After reviewing your membership application information for any missing or incomplete information, you will be contacted by us to complete the registration process.

Thank you!