Community Form - Chabad of Southlake

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*
PrefixFirst NameLast Name
Jewish Name*
Father's Jewish Name*
Mother's Jewish Name*
Occupation*
Work Phone*
- Area CodePhone Number
Cell Phone*
- Area CodePhone Number
E-mail*
Birthday*
/Month /DayYearat

:HourMinutes
Jewish By:*
BirthConversion
Check One:*
CohenLeviYisrael
Household Member 2
Full Name
PrefixFirst NameLast Name
Jewish Name
Father's Jewish Name
Mother's Jewish Name
Occupation
Work Phone
- Area CodePhone Number
Cell Phone
- Area CodePhone Number
E-mail
Birthday
/Month /DayYearat

:HourMinutes
Jewish By:
BirthConversion
Check One:
CohenLeviYisrael
General Information

Home Address*

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

Home Phone*
- Area CodePhone Number
Children
Child 1
First NameMiddle NameLast Name
Jewish Name
Birthday
/Month /DayYearat

:HourMinutes
Child 2
First NameMiddle NameLast Name
Jewish Name
Birthday
/Month /DayYearat

:HourMinutes
Child 3
First NameMiddle NameLast Name
Jewish Name
Birthday
/Month /DayYearat

:HourMinutes
Additional Information
Yahrtzeits
Yahrtzeit 1
Realationship
Date of Passing
/Month /DayYearat

:HourMinutes
Yahrtzeit 2
Realationship
Date of Passing
/Month /DayYearat

:HourMinutes
Yahrtzeit 3
Realationship
Date of Passing
/Month /DayYearat

:HourMinutes
Yahrtzeit 4
Realationship
Date of Passing
/Month /DayYearat

:HourMinutes
Programming
I am interested in receiving information about and participating in the following programs:
Synagogue ServicesAdult EducationHoliday ProgramsHebrew SchoolCamp Gan IsraelWomen's ProgramsVolunteeringTeen ProgramsJewish Youth ZoneJ.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:
365472108150180250360

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty: