Community Form - JewishSouthLake.com

At Chabad of Arlington & The Mid-Cities, we do not currently have a membership structure. We do however serve as a full fledged "Jewish Address" for many in the local Jewish Comunity. In order to help us properly serve all of your needs, we ask that you please take a few moments and fill out the information on this form.
Household Member 1
Full Name*

Prefix First Name Last Name
Jewish Name*
Father's Jewish Name*
Mother's Jewish Name*
Occupation*
Work Phone*

- Area Code Phone Number
Cell Phone*

- Area Code Phone Number
E-mail*
Birthday*

/ Month / Day Year at

: Hour Minutes
Jewish By:*

Birth Conversion
Check One:*

Cohen Levi Yisrael
Household Member 2
Full Name

Prefix First Name Last Name
Jewish Name
Father's Jewish Name
Mother's Jewish Name
Occupation
Work Phone

- Area Code Phone Number
Cell Phone

- Area Code Phone Number
E-mail
Birthday

/ Month / Day Year at

: Hour Minutes
Jewish By:

Birth Conversion
Check One:

Cohen Levi Yisrael
General Information

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone*

- Area Code Phone Number
Children
Child 1

First Name Middle Name Last Name
Jewish Name
Birthday

/ Month / Day Year at

: Hour Minutes
Child 2

First Name Middle Name Last Name
Jewish Name
Birthday

/ Month / Day Year at

: Hour Minutes
Child 3

First Name Middle Name Last Name
Jewish Name
Birthday

/ Month / Day Year at

: Hour Minutes
Additional Information
Yahrtzeits
Yahrtzeit 1
Realationship
Date of Passing

/ Month / Day Year at

: Hour Minutes
Yahrtzeit 2
Realationship
Date of Passing

/ Month / Day Year at

: Hour Minutes
Yahrtzeit 3
Realationship
Date of Passing

/ Month / Day Year at

: Hour Minutes
Yahrtzeit 4
Realationship
Date of Passing

/ Month / Day Year at

: Hour Minutes
Programming
I am interested in receiving information about and participating in the following programs:

Synagogue Services Adult Education Holiday Programs Hebrew School Camp Gan Israel Women's Programs Volunteering Teen Programs Jewish Youth Zone J.U.T.A. - Jewish Student Programming
Chai Club: Financial Support
A crucial element of support for Chabad’s work comes from dedicated individuals who commit to a monthly contribution. These monthly donations add up and make a huge difference in covering Chabad’s operational budget.

Thank G-d, Chabad has grown – and our budget has grown. In order to give EVERYONE an opportunity to help support and be part of the myriad programs and activities, we have established the Chai Club so that everyone can have the opportunity to partner with Chabad and support its ongoing work for our community. By joining the Chai Club you will help support all of Chabad’s activities and programs and you will show your commitment to the community that we have built. Your support will mean so much to us.
Yes! I would like to join the "Chai Club" by making a monthly contribution of:

36 54 72 108 150 180 250 360

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty: