Membership 5781 - Form - B'nai David-Judea Congregation

HOUSEHOLD INFORMATION

Attention current members! Log into your accounts before going any further so that your current data can populate this form.

Please update or fill in any missing or incorrect information. For questions, please email bdj@bnaidavid.com or call 310-276-9269.

* Adult 1 Title

Adult 2 Title

* Adult 1 First Name

Adult 2 First Name

* Adult 1 Last Name

Adult 2 Last Name

* Adult 1 Gender

Adult 2 Gender

Adult 1 Hebrew First Name

Adult 2 Hebrew First Name

Adult 1 Hebrew Father Name

Adult 2 Hebrew Father Name

Adult 1 Hebrew Mother Name

Adult 2 Hebrew Mother Name

* Adult 1 Email

Adult 2 Email

* Adult 1 Mobile Phone

Adult 2 Mobile Phone

Adult 1 Birthdate

Adult 2 Birthdate

* Address

* City

* State

* Zip Code

Home Phone

Tribe

Wedding Anniversary

CHILDREN

* Do you have a child or children ages birth - 5th grade?

Child 1

Child 1 First Name

Child 1 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your child's vaccinations up to date?

Please Select OneYesNo - If you select this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Child 2

Child 2 First Name

Child 2 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your child's vaccinations up to date?

Please Select OneYesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Child 3

Child 3 First Name

Child 3 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your child's vaccinations up to date?

Please Select OneYesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Child 4

Child 4 First Name

Child 4 Last Name

Hebrew Name

Date of Birth

School

Grade / Age

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your child's vaccinations up to date?

Please Select OneYesNo - If you selection this option you must provide a medical exemption in order for your child to attend Rechov Yeladim

Does your child have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

TWEENS / TEENS

* Do you have a child or children in 6th - 12th grades?

Tween / Teen 1

Tween / Teen 1 First Name

Tween / Teen 1 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

* Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your teen's vaccinations up to date?

Please Select OneYesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Tween / Teen 2

Tween / Teen 2 First Name

Tween / Teen 2 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

* Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your teen's vaccinations up to date?

Please Select OneYesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Tween / Teen 3

* Tween / Teen 3 First Name

Tween / Teen 3 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your teen's vaccinations up to date?

Please Select OneYesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

Tween / Teen 4

Tween / Teen 4 First Name

Tween / Teen 4 Last Name

Cell Phone

Hebrew Name

Date of Birth

School

Grade

Allergies

Allergy Severity (check all that apply)

Epi Pen?Airborne Allergy?Contact Allergy?

Are your teen's vaccinations up to date?

Please Select OneYesNo - If you select this option you must provide a medical exemption in order for your child to attend teen programming

Does your tween / teen have any special needs or is there something that would be helpful for us to know?

Please Select OneYesNo

If yes, please elaborate.

CHEVRAS

This summer, we are excited to launch our new Chevra Project! We are focusing our energies on finding more ways to connect with our BDJ family during this time of potential disconnection. To do this, we are creating 'chevras' around either shared experiences or shared interests. Chevras by nature are inclusive and depend on your partnership and suggestions. Our community of BDJ chevras will be a direct outgrowth of what is most meaningful to you!

Household Picture

Part of our goal with the Chevra Project is to allow us to get to know each other better, even though we can't be physically together. Please upload a picture of your household, so that we can share it in our membership directory and also other times during the year as relevant (such as in acknowledging a simcha for your household). We are looking for 100% participation, so thank you in advance for your help in this!

If you haven't already submitted an idea for a chevra, please do so now!

Are you intersted in leading a chevra?

(Choose one)YesNoMaybe

MEMBERSHIP
This year, membership registration and high holiday registration will be separate processes. You will still be entitled to High Holiday seats per the below but we will only share High Holiday information in Elul.

TRUSTEE CIRCLE
Supporters at the Trustee Circle level are the cornerstone of B'nai David-Judea's mission and serve as role models to encourage other congregants to enhance their commitment to our congregation. One advantage of becoming a Trustee Circle member is the unique option to pledge funds just once a year via a streamlined process, rather than multiple times throughout the year. Your gift includes membership and fees, High Holiday seat fees, 2 tickets to the annual banquet and for the silent auction, all four holiday appeals, and mishloach manot.

I would like to pledge for the following membership level:

Please Select OneBDJ Membership - 1 or 2 Adult Household Membership Young Professionals or Associate Trustee Circle Membership - min. $6000 commitment

* Please select a household membership level:

Please Select One2 Adult Household Membership - Includes 2 HHD Tickets - ($1950)1 Adult Household Membership - Includes 1 HHD Ticket ($1200)Young Professional - Includes 1 HHD Ticket & Fees Below Already Included (Single Under 30 $300)Young Professional - Includes 2 HHD Tickets & Fees Below Already Included (Couple Under 30 $500)Associate Membership ($700)Newlyweds-First-Year-of-Marriage-FREE---Donations-always-welcome

Mandatory Fees - Security Fee

Security Fee ($350)I have made alternate arrangements with the office.

Mandatory Fees - Building Maintenance Fee

Building Maintenance Fee ($250)I have made alternate arrangements with the office.

PAYMENT

Your total is below. On the next page, you will be able to set up a credit card payment plan or “bill to account” to pay by check. YOU MUST SELECT A PAYMENT OPTION on the next page for your form to be submitted. Any form without a payment selected WILL NOT BE RECEIVED by the office. If you need payment assistance, please fill out the form and select the “bill to account” option – you may then call the office at 310-276-9269 to discuss a reduced amount or any other arrangements.

We look forward to a meaningful and joyous year together.

This year, more so than others, may be a year when not everyone will be able to support BDJ financially in the way they usually do. If you have the ability to give us extra this year to help make up for those who can't, we thank you in advance for adding a general donation towards membership below.

Membership Additional Donation

Total

CORONAVIRUS

We know that the past few months have been challenging and unique. As a BDJ Family, we would love to hear more about how you and your family are doing (the good and the difficult) so please share that here. Any sensitive information shared will be held in confidence.

You MUST choose a PAYMENT option on the next page for your registration to be complete. If you are unsure what to choose, please select "bill to my account / pay later" so that your registration will still be submitted in the meantime.