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Membership and Household Profile 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.

CONTACT INFORMATION

Filling out this form helps us get to know you better. Fields with an asterisk are required so that we can maintain contact with you. Many fields are optional and are intended to help us learn about you and your interests.

I/We have lived in the area for:

I/We moved here from:

SYNAGOGUE HISTORY

   

HOUSEHOLD PROFILE INFORMATION

     

ADULT 1

(if applicable)

(optional to use Hebrew alphabet)
(optional to use Hebrew alphabet)
(optional to use Hebrew alphabet)


example:  www.linkedin.com/in/yourname




    --- form continues ---

Adult 2

(if applicable)



example:  www.linkedin.com/in/yourname



   

CHILDREN INFORMATION

You may enter information for up to 4 children on this form. If you have 5 or more children in your household, please contact the Beth Am office to provide your children's information.

You may enter adult children information on this form. Household membership includes children ages 23 and under. Separate membership is required for children age 24+.
--- Form Continues ---

CHILD 1










CHILD 2











CHILD 3










CHILD 4








   

REFERRAL INFORMATION


   

BETH AM FRIENDS AND 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")
describe how is this person related to your household
example: Andy's sister

YAHRZEIT INFORMATION

Yahrzeit Information (Anniversary of death)

If you have loved ones regardless of their religious identity, whose names you would like to be placed on our Kaddish list (weekly memorial), please list the names below. It is your choice to observe Yahrzeit on the Hebrew calendar date of death or to use the English calendar date. Please let us know if you would like assistance in determining the Hebrew date. A Yahrzeit reminder will be sent approximately one month prior to date. 

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

OTHER INFORMATION

Beth Am has resources that may be helpful to you and your family. Please indicate any special needs of members of your household that the Congregation should be aware of to assist as needed. Click the + button to add each individual and there tell us how we can help.

EMERGENCY CONTACTS
Please click the + button to add each emergency contact.

PHOTO RELEASE

Release for use of likeness (photo release)

I hereby grant Congregation Beth Am permission to use, in perpetuity, my likeness in photographic or other form in any and all of its publications, and in any and all other media, whether now known or hereafter existing, controlled by Congregation Beth Am or its licensees. I hereby release Congregation Beth Am from any and all liability that may arise out of the use of my likeness.
I hereby grant Congregation Beth Am permission to use, in perpetuity, the likeness of my minor child(ren), in photographic or other form in any and all of its publications, and in any and all other media, whether now known or hereafter existing, controlled by Congregation Beth Am or its licensees. 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 or legal guardian of such child(ren).

MEMBER DIRECTORY LISTING

The Membership directory is a helpful way to connect with other members of the congregation. The online directory is for non-commercial use by members only and requires a Beth Am member account for access.
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.
You can upload a maximum of 2 files.
Optionally, you may submit a photo to be included in our online member directory. Members can change or delete photos from their account using the Beth Am member website.

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 Rachel Tasch 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!

   

Tue, April 20 2021 8 Iyar 5781