FVJC-Emek Shalom Membership Application

Welcome to our application for membership to Farmington Valley Jewish Congregation-Emek Shalom. We are a congregation dedicated to creating, sustaining, and nurturing the Jewish community in the Farmington Valley, and beyond.

If you are interested in receiving general information before applying, please exit out of this application and email membership@fvjc.org.

We are a warm, welcoming and inclusive community, and believe that all members should feel completely comfortable here. As you complete your membership application, please feel free to skip over items that may not apply to you, you are uncomfortable or unable to answer. However, we do require some basic information to be provided (such as name and contact information).

If at any point you have any questions, please feel free to contact our Synagogue Office (admin@fvjc.org) or a member of our Membership Committee (membership@fvjc.org).

A representative from our Membership Committee will contact you by email, once your application has been processed.

We looking forward to getting to know you.

PLEASE NOTE: If you are currently a member of FVJC-EMEK SHALOM, and are completing this form on behalf of a new member, you MUST log out of your FVJC-ES ShulCloud account before completing this form.

If you do not log out of your FVJC-ES ShulCloud account, you may overwrite your current account with the new information contained in this form.

If you have any questions, please contact admin@fvjc.org before completing this form, thank you

Basic Information

* Address Line 1

Address Line 2

* City

* State

* Zip Code

Country

Were you a member of, or attended, a previous congregation(s) in the previous five(5) years? If so, which one(s) and where?

How did you learn about our congregation?

Web search or social media (please use the comments to let us know where)Previously was an FVJC-EMEK SHALOM memberAttended an in-person event or service hosted/sponsored by FVJC-EMEK SHALOMAttended an on-line / virtual event or service hosted/sponsored by FVJC-EMEK SHALOMAttended an event or met Rabbi Bekah GoldmanAttended or event or met Rabbi Gavi RuitFrom a current or former member (please share their name in the comments section)Other (please describe in comments section)

Comments

Member Information

* How many adults are in your household?

Please Select One12

How many children are in your household?

Please Select One01234

For our membership, we define children as unmarried and under the age of 25-years old.

If you have more than four(4) children in your household, please contact the Synagogue Office (admin@fvjc.org).

AMBASSADOR PROGRAM - building connections Our Membership Committee has a program where you can elect be connected with an existing member/member family. This Member will act as an ambassador to help you acclimate to the FVJC-EMEK SHALOM Community. Please indicate if you would like us to make this connection for you:

Yes - I would like to connect with and FVJC-Emek Shalom AmbassadorNo thank you.

Member Information: Adult 1

* Adult 1: First Name

Adult 1: Middle Name

* Adult 1: Last Name

* Adult 1: Email Address

Adult 1: Home Phone

Adult 1: Mobile Phone

Adult 1: Work Phone

Adult 1: Employer

Adult 1: Occupation

Adult 1: Date of Birth

Please read and review the FVJC-ES ETHICS POLICY:

* Ethics Policy Acknowledgement & Agreement

Ethics Policy Acknowledgement & Agreement

I acknowledge that I have received a copy of the FVJC-ES Ethics Policy, that I have read it and understand its contents and I agree to abide by its terms while a member of FVJC-ES. I further acknowledge and understand that my ongoing membership with FVJC-ES is contingent on my complying with the Ethics Policy.

Adult 1: Gender Pronoun

Adult 1: Please share your preferred gender pronouns.

Adult 1: Marital Status

Adult 1: Wedding Date

Tribe

KohenLeviYisraelUnknown

Adult 1: Please share some information on your religious background. (optional)

To help us know you better, and welcome you to our community in a way that you are most comfortable, please share with us your religious background and upbringing.

Adult 1: Hebrew Name

in Hebrew

Adult 1: Hebrew Name

transliterated in English

Adult 1: Father's Hebrew Name

in Hebrew

Adult 1: Father's Hebrew Name

transliterated in English

Adult 1: Mother's Hebrew Name

in Hebrew

Adult 1: Mother's Hebrew Name

transliterated in English

Member Information: Adult 2

* Adult 2: First Name

Adult 2: Middle Name

* Adult 2: Last Name

* Adult 2: Email Address

Adult 2: Home Phone

Adult 2: Mobile Phone

Adult 2: Work Phone

Adult 2: Employer

Adult 2: Occupation

Adult 2: Date of Birth

Adult 2: Gender Pronoun

Adult 2: Please share your preferred gender pronouns.

Adult 2: Marital Status

Adult 2: Wedding Date

Tribe

KohenLeviYisraelUnknown

Adult 2: Please share some information on your religious background. (optional)

To help us know you better, and welcome you to our community in a way that you are most comfortable, please share with us your religious background and upbringing.

Adult 2: Hebrew Name

in Hebrew

Adult 2: Hebrew Name

transliterated in English

Adult 2: Father's Hebrew Name

in Hebrew

Adult 2: Father's Hebrew Name

transliterated in English

Adult 2: Mother's Hebrew Name

in Hebrew

Adult 2: Mother's Hebrew Name

transliterated in English

Member Information: Child 1

Child 1: First Name

Child 1: Middle Name

Child 1: Last Name

Child 1: Gender Pronoun

Child 1: Please share your child's preferred gender pronouns.

Child 1: Date of Birth

Child 1: Current grade in school

Child 1: School attending (name and location)

Child 1: Hebrew Name

in Hebrew

Child 1: Hebrew Name

transliterated in English

Child 1: Has this child had their Bar/Bat Mitzvah?

Please Select OneNoYes

Child 1: Bar/Bat Mitzvah Date

Child 1: Bar/Bat Mitzvah Location

Member Information: Child 2

Child 2: First Name

Child 2: Middle Name

Child 2: Last Name

Child 2: Gender Pronoun

Child 2: Please share your child's preferred gender pronouns.

Child 2: Date of Birth

Child 2: Current grade in school

Child 2: School attending (name and location)

Child 2: Hebrew Name

in Hebrew

Child 2: Hebrew Name

transliterated in English

Child 2: Has this child had their Bar/Bat Mitzvah?

Please Select OneNoYes

Child 2: Bar/Bat Mitzvah Date

Child 2: Bar/Bat Mitzvah Location

Member Information: Child 3

Child 3: First Name

Child 3: Middle Name

Child 3: Last Name

Child 3: Gender Pronoun

Child 3: Please share your child's preferred gender pronouns.

Child 3: Date of Birth

Child 3: Current grade in school

Child 3: School attending (name and location)

Child 3: Hebrew Name

in Hebrew

Child 3: Hebrew Name

transliterated in English

Child 3: Has this child had their Bar/Bat Mitzvah?

Please Select OneNoYes

Child 3: Bar/Bat Mitzvah Date

Child 3: Bar/Bat Mitzvah Location

Member Information: Child 4

Child 4: First Name

Child 4: Middle Name

Child 4: Last Name

Child 4: Gender Pronoun

Child 4: Please share your child's preferred gender pronouns.

Child 4: Date of Birth

Child 4: Current grade in school

Child 4: School attending (name and location)

Child 4: Hebrew Name

in Hebrew

Child 4: Hebrew Name

transliterated in English

Child 4: Has this child had their Bar/Bat Mitzvah?

Please Select OneNoYes

Child 4: Bar/Bat Mitzvah Date

Child 4: Bar/Bat Mitzvah Location

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