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New Family Profile
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We are very pleased that you have chosen to become a member of Makom Solel Lakeside, a warm, welcoming and sacred space. Please tell us all about yourself and your family.
*
Family Last Name
*
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
*
We are an interfaith family
Please Select One
Yes
No
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Home Phone
or Primary Phone number
*
Do you have a seasonal or second address?
Please Select One
Yes
No
*
Seasonal Address
*
Seasonal City
*
Seasonal State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Seasonal Zip Code
*
Seasonal Phone
*
Contact #1 - Title
*
Contact #1 - First Name
*
Contact #1 - Last Name
*
Contact #1 - Preferred Name
Contact #1 - Hebrew Name
*
Contact #1 - Birthdate
*
Contact #1 - Mobile Phone
*
Contact #1 - Email
*
Contact #1 - Business Phone
*
Does Contact #1 have any physical limitations we should be aware of?
Please Select One
Yes
No
*
Contact #1 - Please describe your physical limitation?
ie, vision, hearing, mobility and details for any.
Book Club
Environmental Policies
Cycling Club
Family Friendly Programming
Film Group
Gardening
Health and Wellness
Jewish Baking and Cooking
Music and Choir
MyMakom Women
Parenting Classes
Photography - Camera Club
Prayer and Worship
Shabbat
Social Events and Community Building
Social Justice Projects
Speaker Programs
Spirituality and Mindfullness
Synagogue Governance
Wine Club
Working with Refugee Families
*
Is there a second adult applying for membership?
Please Select One
Yes
No
*
Contact #2 - Title
*
Contact #2 - First Name
*
Contact #2 - Last Name
*
Contact #2 - Preferred Name
Contact #2 - Hebrew Name
*
Contact #1 - Birthdate
*
Contact #2 - Mobile Phone
*
Contact #2 - Email
*
Contact #2 - Business Phone
*
Does Contact #2 have any physical limitations we should be aware of?
Please Select One
Yes
No
*
Contact #2 - Please describe your physical limitation?
ie, vision, hearing, mobility and details for any.
Book Club
Cycling
Environmental Policies
Family Friendly Programming
Film Group
Gardening
Health and Wellness
Jewish Baking and Cooking
Music and Choir
MyMakom Women
Parenting Classes
Photography - Camera Club
Prayer and Worship
Shabbat
Social Events and Community Building
Social Justice Projects
Speaker Programs
Spirituality and Mindfullness
Synagogue Governance
Working with Refugee Families
Wine Club
*
How many children, up to the age of 28, live in the family home or are full-time students?
Please Select One
One child
Two children
Three children
Four children
None
*
Child 1 - First Name
*
Child 1 - Last Name
*
Child 1 - Nick/Preferred Name
*
Child 1 - Hebrew Name
*
Child 1 - Gender
N/A or Unknown
Male
Female
*
Child 1 - Enrolled in Lev learning?
Please Select One
Yes
No
*
Child 1 - School Name
or College Name if applicable
*
Child 1 - School Grade
or College level if applicable
*
Child 1 - College Contact Info
if applicable
*
Child 1 - Does the child have any physical limitations that we should be aware of?
Please Select One
Yes
No
*
Child 1 - Please describe their physical limitation?
ie, vision, hearing, mobility and details for any.
*
Child 2 - First Name
*
Child 2 - Last Name
*
Child 2 - Nick/Preferred Name
*
Child 2 - Hebrew Name
*
Child 2 - Gender
N/A or Unknown
Male
Female
*
Child 2 - Enrolled in Lev learning?
Please Select One
Yes
No
*
Child 2 - School Name
or College Name if applicable
*
Child 2 - School Grade
or College level if applicable
*
Child 2 - College Contact Info
if applicable
*
Child 2 - Does the child have any physical limitations that we should be aware of?
Please Select One
Yes
No
*
Child 2 - Please describe their physical limitation?
ie, vision, hearing, mobility and details for any.
*
Child 3 - First Name
*
Child 3 - Last Name
*
Child 3 - Nick/Preferred Name
*
Child 3 - Hebrew Name
*
Child 3 - Gender
N/A or Unknown
Male
Female
*
Child 3 - Enrolled in Lev learning?
Please Select One
Yes
No
*
Child 3 - School Name
or College Name if applicable
*
Child 3 - School Grade
or College level if applicable
*
Child 3 - College Contact Info
if applicable
*
Child 3 - Does the child have any physical limitations that we should be aware of?
Please Select One
Yes
No
*
Child 3 - Please describe their physical limitation?
ie, vision, hearing, mobility and details for any.
*
Child 4 - First Name
*
Child 4 - Last Name
*
Child 4 - Nick/Preferred Name
*
Child 4 - Hebrew Name
*
Child 4 - Gender
N/A or Unknown
Male
Female
*
Child 4 - Enrolled in Lev learning?
Please Select One
Yes
No
*
Child 4 - School Name
or College Name if applicable
*
Child 4 - School Grade
or College level if applicable
*
Child 4 - College Contact Info
if applicable
*
Child 4 - Does the child have any physical limitations that we should be aware of?
Please Select One
Yes
No
*
Child 4 - Please describe their physical limitation?
ie, vision, hearing, mobility and details for any.
*
How many children 28 or older do you have?
Please Select One
One child
Two children
Three children
Four children
None
*
Older Child 1 - First Name
*
Older Child 1 - Last Name
Older Child 1 - Spouses Name
if applicable
Older Child 1 - Date of Marriage
if applicable
Older Child 1 - Does this child have children?
if applicable please list child(ren)'s names
*
Older Child 2 - First Name
*
Older Child 2 - Last Name
Older Child 2 - Spouses Name
if applicable
Older Child 2 - Date of Marriage
if applicable
Older Child 2 - Does this child have children?
if applicable please list child(ren)'s names
*
Older Child 3 - First Name
*
Older Child 3 - Last Name
Older Child 3 - Spouses Name
if applicable
Older Child 3 - Date of Marriage
if applicable
Older Child 3 - Does this child have children?
if applicable please list child(ren)'s names
*
Older Child 4 - First Name
*
Older Child 4 - Last Name
Older Child 4 - Spouses Name
if applicable
Older Child 4 - Date of Marriage
if applicable
Older Child 4 - Does this child have children?
if applicable please list child(ren)'s names
Please share the names and relationships of your friends and relatives who are currently a part of Makom Solel Lakeside:
Please take a moment and tell us what you expect from your synagogue membership and how we can make a connection with you:
Tell us something about yourself that you'd like to share with your Makom community (ie. I run marathons, I'm on the Library board, or I like to sing)
*
How many names of loved ones would you like to add to our Yahrzeit list?
Please Select One
One yahrzeit
Two yahrzeits
Three yahrzeits
Four yahrzeits
Five yahrzeits
Six yahrzeits
None
*
Yahrzeit 1 - Deceased Name
*
Yahrzeit 1 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 1 - Relationship
*
Yahrzeit 1 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 1 - Date of Death
*
Yahrzeit 2 - Deceased Name
*
Yahrzeit 2 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 2 - Relationship
*
Yahrzeit 2 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 2 - Date of Death
*
Yahrzeit 3 - Deceased Name
*
Yahrzeit 3 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 3 - Relationship
*
Yahrzeit 3 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 3 - Date of Death
*
Yahrzeit 4 - Deceased Name
*
Yahrzeit 4 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 4 - Relationship
*
Yahrzeit 4 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 4 - Date of Death
*
Yahrzeit 5 - Deceased Name
*
Yahrzeit 5 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 5 - Relationship
*
Yahrzeit 5 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 5 - Date of Death
*
Yahrzeit 6 - Deceased Name
*
Yahrzeit 6 - Relative of
Please Select One
Contact 1
Contact 2
*
Yahrzeit 6 - Relationship
*
Yahrzeit 6 - I wish to observe the:
Please Select One
Hebrew date
English date
*
Yahrzeit 6 - Date of Death
Fri, April 19 2024 11 Nisan 5784
