Prospective Member Form

If you are filling out this form on behalf of a family member or friend, you must LOG OUT of your Shulcloud account to ensure that your own information is not overwritten.

Household Information: Prospective Member 1

* First Name

* Last Name

* Birth Date

Gender Identity & Preferred Pronoun

* Email

* Mobile Phone

* Address

(Apt, Suite, etc.)

* City

* State

* ZIP

Household Information: Prospective Member 2 (optional)

First Name

Last Name

Birth Date

Gender Identity & Preferred Pronoun

Mobile Phone

Children (optional)

Please provide the name and birth date of each child

Religious School

Religious SchoolI am interested in enrolling my child(ren) into Religious School

Preschool

PreschoolI am interested in enrolling my child(ren) into the Amy Gail Buchman Preschool

More Info

Former Congregation

Location

How did you hear about us?

Comments

Thank you for submitting your prospective member form. We'll review it and follow up with you soon. If you have any questions, please reach out to Debra Zepeda at dzepeda@zedek.org.

Mon, October 14 2024 12 Tishrei 5785