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Riverdale Temple Membership Application
Please verify reCaptcha before submitting the form.
MEMBERSHIP
APPLICATION
Welcome to Riverdale Temple! We are delighted you have chosen to become part of our community. We hope that you will find membership an enriching experience, and encourage you to explore the diverse opportunities for Jewish expression that Riverdale Temple offers. Feel free to speak with our administrator with any further questions at 718.548.3800.
Personal Information
Is there more than one Adult Member to add to this Application?
Please Select One
Yes
No
Primary Adult
*
First Name
*
Last Name
Hebrew Name
*
Date of Birth
Gender Identity
N/A or Unknown
Male
Female
*
Email
*
Mobile Phone
Check here if you would like to receive Temple communications via email.
Religious Background
Religious background in which you were raised:
Reform
Conservative
Orthodox
Jewish Unaffiliated
Other
Congregation most recently or currently affiliated with
*
Have you had a Bat/Bar Mitzvah?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
*
Have you had Confirmation?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
Please list any relatives who are members of Riverdale Temple
Business Information
Occupation/Title
Area of Specialization
Employer
Secondary Adult
*
First Name
*
Last Name
Hebrew Name
*
Date of Birth
Gender Identity
N/A or Unknown
Male
Female
*
Email
*
Mobile Phone
Check here if you would like to receive Temple communications via email.
Religious Background
Religious background in which you were raised:
Reform
Conservative
Orthodox
Jewish Unaffiliated
Other
Congregation most recently or currently affiliated with
*
Have you had a Bat/Bar Mitzvah?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
*
Have you had Confirmation?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
Please list any relatives who are members of Riverdale Temple
Business Information
Occupation/Title
Area of Specialization
Employer
Family Account Information
*
Home Address
*
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
Home Phone Number
Yahrzeit Information
*
Do you have Yahrzeits to add to this Application?
Please Select One
Yes
No
*
How Many Yahrzeits?
0
1
2
3
4
5
6
7
8
9
10
*
First Name
*
Last Name
Hebrew Name
(if known)
Gender
*
English Date of Death
Before Sundown
Before Sundown
After Sundown
After Sundown
*
I wish to celebrate this Yahrzeit on the:
Please Select One
Gregorian Date
Hebrew Date
*
Name of Member Observing
*
Relationship to Member Observing
Children's Information
*
Do you have Children aged 25 and under to add to this Application?
Please Select One
Yes
No
*
How Many Children?
Please Select One
1
2
3
Please complete this section for your children ages 25 and under. Family Membership includes High Holy Day tickets for you and your children under the age of 26.
Child One
*
First & Middle Name
Last Name
(if different from yours)
Hebrew Name
(if known)
*
Date of Birth
*
Gender Identity
Religious Background
*
Previously attended Religious School?
Please Select One
Yes
No
*
Congregation Name
*
City
*
Had a Bat/Bar Mitzvah?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
*
Had Confirmation?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
Religious School Enrollment
*
Will this child be attending Religious School at Riverdale Temple?
Please Select One
Yes
No
Undecided
Child Two
*
First & Middle Name
Last Name
(if different from yours)
Hebrew Name
(if known)
*
Date of Birth
*
Gender Identity
Religious Background
*
Previously attended Religious School?
Please Select One
Yes
No
*
Congregation Name
*
City
*
Had a Bat/Bar Mitzvah?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
*
Had Confirmation?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
Religious School Enrollment
*
Will this child be attending Religious School at Riverdale Temple?
Please Select One
Yes
No
Undecided
Child Three
*
First & Middle Name
Last Name
(if different from yours)
Hebrew Name
(if known)
*
Date of Birth
*
Gender Identity
Religious Background
*
Previously attended Religious School?
Please Select One
Yes
No
*
Congregation Name
*
City
*
Had a Bat/Bar Mitzvah?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
*
Had Confirmation?
Please Select One
Yes
No
*
Date
*
Congregation Name
*
City
Religious School Enrollment
*
Will this child be attending Religious School at Riverdale Temple?
Please Select One
Yes
No
Undecided
Emergency Contact Information
Please list two people other than the co-applicants.
*
Full Name
*
Relationship
Home Phone
Mobile Phone
*
Full Name
*
Relationship
Home Phone
Mobile Phone
Opportunities for Participation, Talents, and Interests
At Riverdale Temple, we believe that joining a congregation is a spiritual and emotional commitment. We encourage all congregants to become involved in all aspects of life in our congregational community. In furthering this ideal, we request that upon signing this application, you commit to participate in congregational life. Please indicate which of the areas below may interest you by checking the appropriate box or boxes. Your participation will help strengthen the community, and will make your temple experience more meaningful. You will be contacted by a board member with more information.
Primary Adult
Adult Learning
Advertising and Publicity
Assisting with Office Work
Budget and Finance
Bulletin Writing and Editing
Choir
Fundraising
Holiday Celebration and/or Decoration
Library
Membership
Men's Club
Religious School Activities and Projects
Sisterhood/WRJ
Social Action and Mitzvah Projects
Transportation
Visiting the Sick and Bereaved
Youth Activities
Auto Repair
Acting
Baking or Cooking
Gardening
Painting or Art
Plumbing, Electrical, or Carpentry
Public Relations
Sewing or Needlework
Travel
Other Interests
Secondary Adult
Adult Learning
Advertising and Publicity
Assisting with Office Work
Budget and Finance
Bulletin Writing and Editing
Choir
Fundraising
Holiday Celebration and/or Decoration
Library
Membership
Men's Club
Religious School Activities and Projects
Sisterhood/WRJ
Social Action and Mitzvah Projects
Transportation
Visiting the Sick and Bereaved
Youth Activities
Auto Repair
Acting
Baking or Cooking
Gardening
Painting or Art
Plumbing, Electrical, or Carpentry
Public Relations
Sewing or Needlework
Travel
Other Interests
Member Agreement
Your application to Riverdale Temple will be fully processed upon receipt of membership dues.
Fees: $1,711.00 (single member); $3,111.00 (family).
The undersigned agrees that they are obligated to pay financial responsibilities associated with membership in Riverdale Temple. It is further understood that should the undersigned resign their membership, they remain liable for any outstanding obligations to Riverdale Temple.
Primary Adult
*
I am applying to become a Riverdale Temple member.
I am applying to become a Riverdale Temple member.
*
Signature
*
Date
Secondary Adult
*
I am applying to become a Riverdale Temple member.
I am applying to become a Riverdale Temple member.
*
Signature
*
Date
Sun, September 1 2024 28 Av 5784
