New Member Application

Shalom! Thank you for your interest in joining our Temple Israel of Hollywood community. The following application will help us get to know you [and other members of your household] as we steward your Jewish journey with us. Thank you for your time and interest.

Step 1 of 21 – Religious School

Primary Membership Holder(s)

This section collects information about your household as a whole. Please use subsequent sections of this form to provide individual family member information.

Adult Family Member 1 Full Name(Required)

This individual will be considered the PRIMARY CONTACT for your household membership.

Adult Family Member 2 Full Name

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Marital Status(Required)

Partners/Married

Single

Divorced

Separated

Widowed

Wedding Anniversary (if applicable)

Month

Day

Year

How did you hear about TIOH? (Please check all that apply)(Required)

Referred by member

Website

Jewish publication

Live in neighborhood

Other (fill out below)

How Hear Other

Reason(s) for joining (Please check all that apply)(Required)

Worship services

Children in one of TIOH’s schools (BNECC, Briskin, Religious School)

B’nai mitzvah

Commitments to social action/justice

New to area

Adult learning

Community

Other (fill out below)

Join Reason Other

Areas of interest (Please check all that apply)

Adult Education (Torah and text study, Jewish values, hot topics)

Arts and Culture activities (film, music, live performances, artist talks, dance, comedy, writing)

Athletics (sports, hiking)

Book groups

Israel

LGBTQI+

Men’s Programming

Professional Networking

Social Justice (please share the issues you are passionate about in the ‘other’ column)

Spiritual Practice (prayer services, mindfulness practice, yoga)

Women’s Programming

Support groups (grief, divorce, menopause, transitions)

Volunteer Opportunities

Young Adult Networking (20s – 30s)

Youth Programming/Education

Other Areas of Interest

If applicable, please list present affiliations in LA civic/cultural clubs and Jewish/community organizations.

Would you like to have a meeting with one of our rabbis?(Required)

Yes

Please select the rabbi you prefer to meet with

Adult Family Member 1

Please answer the following questions regarding the primary membership holder for your household. At the end of this section, you will be given the opportunity to add an additional adult membership holder (spouse/partner).

Name(Required)

Prefix First Middle Last Suffix

Preferred Name or Nickname (if different from above)

Maiden Name (if applicable)

Does this member have a Ritual Name (Hebrew, Yiddish, Other)?(Required)

Yes

Preferred Relation (select one)(Required)

Ritual Name(Required)

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns

Date of birth(Required)

Month

Day

Year

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

Home Phone

Occupation/Profession

Business Name

Business Address

Street Address Address Line 2 City State ZIP Code

Business Phone

What is your religious background?(Required)

Reform

Conservative

Orthodox

Reconstructionist

Non-Denominational

Jew-By-Choice

Secular

Non-Practicing

Other

Current or previous affiliation with religious institutions

Please list any relationships you have to any member(s) of TIOH

Would you like to add a spouse/partner?(Required)

Yes

Adult Family Member 2

Name(Required)

Prefix First Middle Last Suffix

Preferred Name or Nickname (if different from above)

Maiden Name (if applicable)

Does this member have a Ritual Name (Hebrew, Yiddish, Other)?(Required)

Yes

Preferred Relation (select one)(Required)

Ritual Name(Required)

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns

Date of birth(Required)

Month

Day

Year

Email(Required)

Enter Email Confirm Email

Cell Phone(Required)

Occupation/Profession

Business Name

Business Address

Street Address Address Line 2 City State ZIP Code

Business Phone

What is their religious background?(Required)

Reform

Conservative

Reconstructionist

Non-Denominational

Jew-By-Choice

Secular

Non-Practicing

Other

Current or previous affiliation with religious institutions

Please list any relationships you have to any member(s) of TIOH

Children

Do you have a child / children?(Required)

Yes

Are any of your children under the age of 18?(Required)

Yes

Child 1 – UNDER 18

Name(Required)

Prefix First Middle Last Suffix

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Where does your child go to school?(Required)

BNECC

Briskin Elementary School

TIOH Religious School

Other

"Other" school name(Required)

Would you like to add another child UNDER 18?(Required)

Yes

Child 2 – UNDER 18

Name(Required)

Prefix First Middle Last Suffix

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Where does your child go to school?(Required)

BNECC

Briskin Elementary School

TIOH Religious School

Other

"Other" school name(Required)

Would you like to add another child UNDER 18?(Required)

Yes

Child 3 – UNDER 18

Name(Required)

Prefix First Middle Last Suffix

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Where does your child go to school?(Required)

BNECC

Briskin Elementary School

TIOH Religious School

Other

"Other" school name(Required)

Would you like to add another child UNDER 18?(Required)

Yes

Child 4 – UNDER 18

Name(Required)

Prefix First Middle Last Suffix

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Where does your child go to school?(Required)

BNECC

Briskin Elementary School

TIOH Religious School

Other

"Other" school name(Required)

Children (Continued)

Are any of your children OVER 18 years of age?(Required)

Yes

Child 1 – OVER 18

Name(Required)

Prefix First Middle Last Suffix

Maiden Name (if applicable)

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Current School (College/University) or Occupation

Expected graduation year

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of spouse / partner (if applicable)

First Last

Would you like to add another child OVER 18?(Required)

Yes

Child 2 – OVER 18

Name(Required)

Prefix First Middle Last Suffix

Maiden Name (if applicable)

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Current School (College/University) or Occupation

Expected graduation year

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of spouse / partner (if applicable)

First Last

Would you like to add another child OVER 18?(Required)

Yes

Child 3 – OVER 18

Name(Required)

Prefix First Middle Last Suffix

Maiden Name (if applicable)

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns Adult Child 3(Required)

Current School (College/University) or Occupation

Expected graduation year

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Spouse / Partner (if applicable)

First Last

Would you like to add another child OVER 18?(Required)

Yes

Child 4 – OVER 18

Name(Required)

Prefix First Middle Last Suffix

Maiden Name (if applicable)

Date of birth(Required)

Month

Day

Year

Preferred Pronouns(Required)

He / Him

She / Her

They / Them

Other

Other Preferred Pronouns(Required)

Current School (College/University) or Occupation

Expected graduation year

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Spouse/Partner (if applicable)

First Last

Vehicle Information – 1

For security purposes, please provide us with the following information regarding your family’s vehicle(s)

Vehicle 1 Make(Required)

Vehicle 1 Make Other(Required)

Vehicle 1 Model(Required)

Vehicle 1 Color(Required)

Vehicle 1 License Plate(Required)

Would you like to add an additional vehicle?(Required)

Yes

Vehicle Information – 2

For security purposes, please provide us with the following information regarding your family’s vehicle(s)

Vehicle 2 Make(Required)

Vehicle 2 Model(Required)

Vehicle 2 Color(Required)

Vehicle 2 License Plate(Required)

Would you like to add an additional vehicle?(Required)

Yes

Vehicle Information – 3

Vehicle 3 Make(Required)

Vehicle 3 Model(Required)

Vehicle 3 Color(Required)

Vehicle 3 License Plate(Required)

Yahrzeit Information

Would you like to submit Yahrzeit (anniversary of death) information for a loved one?(Required)

Yes

To prevent your application from being submitted multiple times, please select “Submit” only once.

Individual Yahrzeit Information – 1

Name(Required)

First Last

Date of Death(Required)

Month

Day

Year

Relationship to member(Required)

Ex. “Mother of John Smith”

Would you like to add Yahrzeit information for an additional loved one?(Required)

Yes

To prevent your application from being submitted multiple times, please select “Submit” only once.

Individual Yahrzeit Information – 2

Name(Required)

First Last

Date of Death(Required)

Month

Day

Year

Relationship to member(Required)

Ex. “Mother of John Smith”

Would you like to add Yahrzeit information for an additional loved one?(Required)

Yes

To prevent your application from being submitted multiple times, please select “Submit” only once.

Individual Yahrzeit Information – 3

Name(Required)

First Last

Date of Death(Required)

Month

Day

Year

Relationship to member(Required)

Ex. “Mother of John Smith”

Would you like to add Yahrzeit information for an additional loved one?(Required)

Yes

To prevent your application from being submitted multiple times, please select “Submit” only once.

Individual Yahrzeit Information – 4

Name(Required)

First Last

Date of Death(Required)

Month

Day

Year

Relationship to member(Required)

To prevent your application from being submitted multiple times, please select “Submit” only once.

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