Please use this form to request membership. If you have any questions or issues, please contact the CKA office at 972-539-1938.

- Step 1 of 8

Member Information

Please enter in the information for the primary adult member(s).

Adult 1 *

First

Middle

Last

Title (Optional)

Preferred Name

Gender *

Male
Female

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Phone Type *

Home
Cell
Work

Please indicate the type of phone for the number above.

Add another phone number? *

2nd Phone

2nd Phone Type

Home
Cell
Work

Add a 3rd phone number?

3rd Phone

3rd Phone Type

Home
Cell
Work

Email *

Occupation *

Date of Birth *

Marital Status *

Single
Married
Divorced
Widowed

Date of Marriage *

Are you Jewish? *

Hebrew Name

Name of Last Temple Affiliated with and Location

Jewish Background

Read Hebrew
Speak Hebrew
Read Torah

Please check all that apply.

Religion *

If you are not Jewish, please indicate your religion.

Add another adult?

Adult 2 *

First

Middle

Last

Does this adult have a different address? *

Title (Optional)

Preferred Name

Gender *

Male
Female

Secondary Address *

Address Line 1

Address Line 2

City

State

Zip Code

2nd Adult's Phone *

2nd Adult's Phone Type *

Home
Cell
Work

Please indicate the type of phone for the number above.

Add another phone number? (Adult 2) *

2nd Phone (2nd Adult)

2nd Phone Type (2nd Adult)

Home
Cell
Work

Add a 3rd Phone number? (2nd Adult)

3rd Phone (2nd Adult)

3rd Phone Type (2nd Adult)

Cell
Home
Work

Email *

Date of Birth *

Occupation *

Marital Status *

Single
Married
Divorced

Are you Jewish? *

Hebrew Name

Jewish Background

Read Hebrew
Speak Hebrew
Read Torah

Please check all that apply.

Religion *

If you are not Jewish, please indicate your religion.

Emergency Contact

Please specify the contact in case of emergency.

Emergency Contact Name *

First

Last

Relationship *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Please provide the best number for your emergency contact.

Additional Adults Living in the Household

This form only supports the addition of up to 2 more adult family members living in the house. If you need to add more than that, please contact the office to have those adults added manually.

Are there any additional adults living in the house that should be included in the membership? *

Name *

First

Middle

Last

Date of Birth *

Relationship *

Are they Jewish? *

Hebrew Name

Jewish Background

Read Hebrew
Speak Hebrew
Read Torah

Please check all that apply.

Religion *

If you are not Jewish, please indicate your religion.

Is there a 4th adult living in the house? *

Name *

First

Middle

Last

Date of Birth *

Relationship *

Are they Jewish? *

Hebrew Name

Jewish Background

Read Hebrew
Speak Hebrew
Read Torah

Religion *

If you are not Jewish, please indicate your religion.

Children

This form supports up to 3 children. If you need to add additional children, please complete the form and then contact the office. They will assist you in adding them.

Do you have any children to add to the membership? *

1st Child's Name *

First

Middle

Last

1st Child's Hebrew Name

1st Child's Birthdate *

Will they attend Religious School? *

Planning a B'nai Mitzvah? *

Does the child reside in the same household? *

1st Child's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a 2nd child to add to the membership? *

2nd Child's Name *

First

Middle

Last

2nd Child's Hebrew Name

2nd Child's Birthdate *

Will they attend Religious School? *

Planning a B'nai Mitzvah? *

Does the child reside in the same household? *

2nd Child's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a 3rd child to add to the membership? *

3rd Child's Name *

First

Middle

Last

3rd Child's Hebrew Name

3rd Child's Birthdate *

Will they attend Religious School? *

Planning a B'nai Mitzvah? *

Does the child reside in the same household? *

3rd Child's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Yahrzeits

This form supports up to 7 yahrzeits added online. If after completing the form you have additional yahrzeits to be added, please contact the CKA office. They will assist you in adding them.

Would you like to add any yahrzeits? *

Please specify which type of date you prefer to observe for your yahrzeit(s)? *

Gregorian
Hebrew

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add another yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add 3rd yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add 4th yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add 5th yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add 6th yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Would you like to add 7th yahrzeit? *

Name *

First

Last

Relationship *

Be sure to include to whom in the family the relationship is connected.

Gregorian Date *

Hebrew Date

If you don't know this, you can leave it blank. We will retrieve it for you.

Interests and Activities

Please check all below that apply to any member of the family.

We are interested in the following:

Sisterhood
Jr. Youth Group (Grades 6-8)
Sr. Youth Group (Grades 9-12)
Youth Group Advisor
Education Committee
Religious School Teaching
Hebrew Teaching
Choir
Communication Committee
Ritual Committee
Tikkun Olam Committee
Building Committee
New Members Committee
Membership Support Committee
Budget & Finance Committee
Fundraising Committee
Cemetery Committee

Other Areas:

Please indicate any other areas that are special interest to you that are not listed above.

Special Talents

Please tell us about any special talents you would like to share with the congregation.

Where did you hear about us? *

Search Engine (Google, Bing, etc.)
Social Media (Facebook, Twitter, Instagram)
Current congregant or community member
Mailing I Received
Other

Since you indicated 'Other', please tell us where. *

Comments/Questions

If you have any additional information we need or have any questions we can answer for you, please enter them here.

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Member Information

Emergency Contact

Additional Adults Living in the Household

Children

Yahrzeits

Interests and Activities

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Upcoming Events

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Member Information

Emergency Contact

Additional Adults Living in the Household

Children

Yahrzeits

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