Congregation Beth Am of Los Altos Hills, CA
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.
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SYNAGOGUE HISTORY
* Previous Synagogue Affiliation or Participation?Please Select One Yes No
HOUSEHOLD PROFILE INFORMATION
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ADULT 1
Adult 1 - Gender N/A or Unknown Male Female
Adult 1 - Ben/Bat Please Select One ben bat
* Adult 1 - Religious Background in which you were raisedPlease Select One Jewish Not Jewish
Adult 1 - Are you currently: Please Select One Converted to Judaism (Jew by choice) In the process of converting to Judaism Thinking about converting to Judaism Affiliated with another religion No religious affilition
* Relationship StatusPlease Select One Single Divorced Separated Widowed Engaged Partnered Married
Adult 2
Adult 2 - Gender N/A or Unknown Male Female
Adult 2 - Ben/Bat Please Select One ben bat
* Adult 2 - Religious Background in which you were raisedPlease Select One Jewish Not Jewish
Adult 2 - Are you currently: Please Select One Converted to Judaism (Jew by choice) In the process of converting to Judaism Thinking about converting to Judaism Affiliated with another religion No religious affiliation
CHILDREN INFORMATION
How many children will be included on your household membership Please Select One No Children One Child Two Children Three Children Four Children Five or More Children 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.
CHILD 1
Child 1 - Education Level Please Select One Pre-K through 12th Grade Post High School
* Child 1 - Does the child belong to Beth AmPlease Select One Yes No
* Child 1 - Current GradePlease Select One Pre-K K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th GradePre-K 10th Grade 11th Grade 12th Grade
* What religious education has Child #1 completed? (Check all that apply)Please Select One No prior religious education Preschool Religious School (Pre-K to 8th Grade) Religious School (9th to 12th Grade) Hebrew School Youth Groups
Confirmation Please Select One Yes No
Child 1 - Is Child still a student? Please Select One Yes No
* Child 1 - Does the child have a spouse or partner?Please Select One Yes No
* Child 1 - Does the child have children?Please Select One Yes No
CHILD 2
* Child 2 - Education LevelPlease Select One Pre-K through 12th Grade Post High School
* Child 2 - Does the child belong to Beth AmPlease Select One Yes No
Child 2 - Current Grade Please Select One Pre-K K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Confirmation Please Select One Yes No
Child 2 - Is Child still a student? Please Select One Yes No
Child 2 - Does the child have a spouse or partner? Please Select One Yes No
* Child 2 - Does the child have children?Please Select One Yes No
CHILD 3
* Child 3 - Education LevelPlease Select One Pre-K through 12th Grade Post High School
* Child 3 - Does the child belong to Beth AmPlease Select One Yes No
Child 3 - Current Grade Please Select One Pre-K K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Confirmation Please Select One Yes No
Child 3 - Is Child still a student? Please Select One Yes No
Child 3 - Does the child have a spouse or partner? Please Select One Yes No
* Child 3 - Does the child have children?Please Select One Yes No
CHILD 4
Child 4 - Education Level Please Select One Pre-K through 12th Grade Post High School
* Child 4 - Does the child belong to Beth AmPlease Select One Yes No
Child 4 - Current Grade Please Select One Pre-K K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Confirmation Please Select One Yes No
Child 4 - Is Child still a student? Please Select One Yes No
Child 4 - Does the child have a spouse or partner? Please Select One Yes No
Child 4 - Does the child have children? Please Select One Yes No
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")
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.
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.
Is there anything else you would like to know about Congregation Beth Am?
EMERGENCY CONTACTSPlease click the + button to add each emergency contact.
PHOTO RELEASE
Release for use of likeness (photo release)
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.
Upload a photo (optional)
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.
We strive to live as a holy community whose study and practice of Judaism inspires and challenges us to "do justice, to love kindness and to walk humbly with our God" (Micah 6:8).