Membership Application - Form

ShulCloud allows for some diversity of gender terms so we did what we could, and we apologize for the limitations that exist.

* Adult 1 - First Name

* Adult 1 - Last Name

Adult 1 - Nickname

if applicable

Adult 1 - Hebrew Name

enter in Hebrew or English

Adult 1 - Date of Birth

Adult 1 - Were you born before or after sunset?

Adult 1 - Preferred pronouns

Adult 1 - I can leyn (chant) Torah

* Adult 1 - Email Address

* Adult 1 - Mobile Phone

Adult 1 - Home Phone

Adult 1 - What is your preferred method of communication?

Cell PhoneEmailHome Phone

* Adult 1 - Home Address

Adult 1 - Address 2

* Adult 1 - City

* Adult 1 - State

* Adult 1 - Zip Code

Choose the information you would you like to include in our secure online Members Directory:

Adult 1 - First and Last Name

Adult 1 - Nickname

Adult 1 - Cell Phone

Adult 1 - Email Address

Adult 1 - Home Phone

Adult 1 - Street Address

Chochmat HaLev is supported by the energy of our members, who actively participate through their time and talent. What skills, expertise, or enthusiasm might you like to offer our community? Please let us know how you would like to participate. Our request is that each member volunteers 10 hours a year.

Adult 1 - Other Hobbies or Skills

As a member of Chochmat HaLev, you will have many opportunities to be involved in a wide variety of interesting activities. These activities center on learning, spiritual growth, community service, and socializing. Let us know what most interests you!

Adult 1 - Other areas of interest

* Is there a second adult included in this membership?

* Adult 2 - First Name

* Adult 2 - Last Name

Adult 2 - Nickname

if applicable

Adult 2 - Hebrew Name

enter in Hebrew or English

Adult 2 - Date of Birth

Adult 2 - Were you born before or after sunset?

Adult 2 - Preferred pronouns

Adult 2 - I can leyn (chant) Torah

* Adult 2 - Email Address

* Adult 2 - Mobile Phone

Adult 2 - Home Phone

Adult 2 - What is your preferred method of communication?

Cell PhoneEmailHome Phone

Choose the information you would you like to include in our secure online Members Directory:

Adult 2 - First and Last Name

Adult 2 - Nickname

Adult 2 - Cell Phone

Adult 2 - Email Address

Adult 2 - Other Hobbies or Skills

Adult 2 - Other Areas of Interest

* Adult 2 - Does Adult 2 live at the same address as Adult 1?

* Adult 2 - Home Address

* Adult 2 - Address 2

* Adult 2 - City

* Adult 2 - State

* Adult 2 - Zip Code

As a member, you may add the names of your deceased loved ones to our weekly Kaddish list. Please list all information below. You may also add this information later in My Account.

How many yahrzeits would you like to observe?

Name (English)

Hebrew name

Date/year of death

Before or after sunset?

Name (English)

Hebrew name

Date/year of death

Before or after sunset?

Name (English)

Hebrew name

Date/year of death

Before or after sunset?

Name (English)

Hebrew name

Date/year of death

Before or after sunset?

List all children under the age of 30 who live in your home so they can be included in your membership.

* How many children under the age of 30 live in the family home?

* Child 1 - First Name

Child 1 - Middle Name

* Child 1 - Last Name

* Child 1 - Preferred name

* Child 1 - Birth Date

* Child 1 - Preferred pronoun

* Child 1 - Email Address

Child 1 - Cell Phone

* Child 1 - Are you interested in our Jewish School Youth Program?

For children aged 13 and under.

Child 1 - Bar/Bat Mitzvah: Date, Congregation, City

Child 1 - Confirmation: Date, Congregation, City

Child 1 - Photograph

Please attach a photo of Child 1 above.

* Child 2 - First Name

Child 2 - Middle Name

* Child 2 - Last Name

Child 2 - Preferred Name

* Child 2 - Birth Date

* Child 2 - Preferred pronoun

* Child 2 - Email Address

Child 2 - Cell Phone

* Child 2 - Are you interested in our Jewish School Youth Program?

For children aged 13 and under.

Child 2 - Bar/Bat Mitzvah: Date, Congregation, City

Child 2 - Confirmation: Date, Congregation, City

Child 2 - Photograph

Please attach a photo of Child 2 above.

* Child 3 - First Name

Child 3 - Middle Name

* Child 3 - Last Name

Child 3 - Preferred Name

* Child 3 - Birth Date

* Child 3 - Preferred pronoun

* Child 3 - Email Address

Child 3 - Cell Phone

* Child 3 - Are you interested in our Jewish School Youth Program?

For children aged 13 and under.

Child 3 - Bar/Bat Mitzvah: Date, Congregation, City

Child 3 - Confirmation: Date, Congregation, City

Child 3 - Photograph

Please attach a photo of Child 3 above.

* Child 4 - First Name

Child 4 - Middle Name

* Child 4 - Last Name

Child 4 - Preferred Name

* Child 4 - Birth Date

* Child 4 - Preferred pronoun

* Child 4 - Email Address

Child 4 - Cell Phone

* Child 4 - Are you interested in our Jewish School Youth Program?

For children aged 13 and under.

Child 4 - Bar/Bat Mitzvah: Date, Congregation, City

Child 4 - Confirmation: Date, Congregation, City

Child 4 - Photograph

Please attach a photo of Child 4 above.

Is your family related to a current Chochmat HaLev member? If so, who?

Our membership year runs from July through June. By signing up now, your membership will be valid from today through June 30th, 2024. Membership renews automatically each year. You may contact us at shalom@chochmat.org anytime to make changes to your membership.

Having given some serious thought to the meaning of synagogue affiliation, I/we make commit to paying the membership dues selected below. I/we understand the standards of behavior, dues structure, and the request to volunteer, I/we agree to pay my/our annual commitments.

No One Turned Away

It is a longstanding policy that membership will not be denied due to inability to pay the requested dues. However, this policy is only feasible when all members support Chochmat HaLev to the best of their ability. We hope that each of our members will give of their time and talent, as well as give according to their financial ability. We will leave it to you to decide what you can give.

Membership Levels:

Spirit | Atzilut
$220/month – 1-adult household
$430/month – 2-adult household

Intellect | Briyah
$175/month – 1-adult household
$340/month – 2-adult household

Emotion | Yetzirah
$125/month – 1-adult household
$240/month – 2-adult household

Action | Assiyah
$85/month – single adult

Choose a Different Amount

* Please choose a Dues Level:

SPIRIT For individuals and families who can give a little more. I/We wish to sustain the fire and essence of our community into the future.

THOUGHT - This level truly sustains us. I/We wish to support the opportunities of our community to learn by supporting our teachers and spiritual leaders.

EMOTION - For individuals and families who can give more than $85/month. I/We bring the offerings of my heart: myself and my sacred family to this community.

ACTION - For single adults. I/We wish to embrace my community in the tangible world.

Choose a Different Amount - I/We wish to give the following total amount (for all of 5784):

* CONSENT TO USE IMAGE - I give permission to Chochmat HaLev to use my image for online and print purposes.

* STANDARDS OF BEHAVIOR - In joining Chochmat HaLev as a member, I/we agree to uphold the physical, emotional, and spiritual safety of all members of the community at all of Chochmat HaLev’s functions and events. As a member, I/we agree to act in ways that respect the sacred communal space where we gather and pray.  In the event that I violate these Standards of Behavior, I acknowledge that the Board of Directors reserves the right to bar me from participating in Chochmat HaLev’s services, programs, and community. By becoming a member of Chochmat HaLev, I agree to abide by any determinations made by the Board. By checking the box, I/we agree to uphold these community standards of behavior.

STANDARDS OF BEHAVIOR - In joining Chochmat HaLev as a member, I/we agree to uphold the physical, emotional, and spiritual safety of all members of the community at all of Chochmat HaLev’s functions and events. As a member, I/we agree to act in ways that respect the sacred communal space where we gather and pray.  In the event that I violate these Standards of Behavior, I acknowledge that the Board of Directors reserves the right to bar me from participating in Chochmat HaLev’s services, programs, and community. By becoming a member of Chochmat HaLev, I agree to abide by any determinations made by the Board. By checking the box, I/we agree to uphold these community standards of behavior.

How did you find out about Chochmat HaLev?

Did someone introduce you Chochmat? If so, who

We are delighted that you have chosen to join Chochmat HaLev. Please let us know what motivated you to do so.

Total Commitment