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Temple Shalom New Membership Application
Please verify reCaptcha before submitting the form.
If you need help filling out the form, please contact the office at (973) 584-5666 or
administrator@tshalom.org
. Thank you!
Account Information
Preferred Pronouns
Title
*
First Name-Adult 1
*
Last Name-Adult 1
*
DOB-Adult 1
Preferred phone
Home
Mobile
*
Mobile Phone-Adult 1
Home Phone-Adult 1
*
Email-Adult 1
May we list your information in our online Member Directory?
Yes
No
*
Address 1
Address 2
*
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
*
Occupation/Profession & Position/Title
Company Name
Specializations/Areas of expertise (work or other)
*
Marital Status
Married/Partners
Divorced/Separated
Single
Widowed
Anniversary Date (MM/DD/YY)
Hebrew Name
Phonetically-- example Malka ben/bat Yakov/Yohevet
*
1. Would you like to add another adult to your account?
Please Select One
Yes
No
NOTE:
Either as the second member on your account; or just as another contact for Temple Shalom.
Preferred pronouns
Title
*
First Name-Adult 2
*
Last Name-Adult 2
*
DOB-Adult 2
*
Preferred phone
Home
Mobile
*
Mobile Phone-Adult 2
Home Phone-Adult 2
*
Email-Adult 2
*
Occupation/Profession & Position/Title
Company Name
Specializations/Areas of expertise (work or other)
Hebrew Name
Phonetically-- example Malka ben/bat Yakov/Yohevet
*
2. Are there any children you would like associated with your account?
Please Select One
Yes
No
18 years or younger
3. Please select the # of children
Please Select One
1
2
3
4
Preferred Pronouns
First Name-Child 1
Last Name-Child 1
DOB-Child 1 (MM/DD/YY
Grade for 2022/2023 school year
K
1
2
3
4
5
6
7
8
9
10
11
12
District/Name of School
Hebrew Name-Child 1
Phonetic
Bar/Bat Mitzvah date-Child 1
if past, or if known for future
Confirmation Date-Child 1
if past
Preferred pronouns
First Name-Child 2
Last Name-Child 2
DOB-Child 2
Grade for 2022/2023 school year
K
1
2
3
4
5
6
7
8
9
10
11
12
District/Name of School
Hebrew Name-Child 2
Phonetic
Bar/Bat Mitzvah date-Child 2
if past, or known for future
Confirmation Date-Child 2
Preferred pronouns
First Name-Child 3
Last Name-Child 3
DOB-Child 3
Grade for 2022/2023 school year
K
1
2
3
4
5
6
7
8
9
10
11
12
District/Name of School
Hebrew Name-Child 3
phonetic
Bar/Bat Mitzvah date-Child 3
if past, or known for future
Confirmation Date- Child 3
Preferred pronouns
First Name-Child 4
Last Name-Child 4
Birth Date-Child 4 (MM/DD/YYYY)
Grade for 2021/2022 school year
K
1
2
3
4
5
6
7
8
9
10
11
12
District/Name of School
Hebrew Name-Child 4
phonetic
Bar/Bat Mitzvah date-Child 4
if past, or known for future
Confirmation Date- Child 4
*
4. Will you be registering your child(ren) for Temple Shalom's Religious School?
Please Select One
Yes
No
Religious School Registration Part 1
This is Part 1 in Religious School Registration.
Upon submission of this form you will receive a confirmation email with the link to Part 2: Religious School Registration Form 2022-2023 (5783), please submit both forms to be fully registered for Religious School.
*
1. Please select the grade(s) your child(ren) will be attending in Religious School this upcoming year:
Tuition Only K-2
Grades K-2
Grades 3-7
Grades 8-10
Grades 11 & 12
Membership Information
Member Acknowledgement
Your Estimated Obligation
*You will be billed separately for your building fund (if applicable).
**If you are in the process of requesting Special Arrangements, this amount does not reflect your Obligation.
*
By checking this box, I hereby acknowledge that:
By checking this box, I hereby acknowledge that:
All information provided is accurate to the best of my knowledge.
In the future, Temple Shalom Membership shall automatically renew at the start of the fiscal year, July 1st.
I am responsible for all financial obligations that I incur with Temple Shalom.
Special Arrangements do not renew automatically and must be requested each year (with supporting documentation), before the start of the fiscal year, July 1st. In the absence of a request and all supporting documentation from me, Temple Shalom will assume my financial hardship has been resolved and I will be renewing my full membership contribution to the community.
Temple Shalom Membership renewal will be done at the same membership category, same prevailing dues level, and with the same payment method at the time of renewal, unless I inform Temple Shalom in writing before the start of the fiscal year, July 1st.
It is my responsibility to contact Temple Shalom if there are any changes to my payment method, membership status, and/or information concerning members of my household.
Fri, April 11 2025 13 Nisan 5785
