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Congregation Shir Tikvah Membership Application
Please verify reCaptcha before submitting the form.
Thank you for submitting a membership application to Shir Tikvah! We are so thrilled that you have chosen to join our incredible community. You will be contacted by our office staff within 3 business days to welcome you and confirm your membership was approved.
PERSONAL
INFORMATION
ADULT #1:
*
First Name
*
Last Name
Nickname
Hebrew Name (if applicable)
*
Birthdate
Gender (optional)
Pronouns
Home Phone
*
Email Address
*
May we publish your email address in our directory?
Yes
No
*
Adult #1: Cell Phone Number
*
May we publish your cell phone number in our directory?
Yes
No
Marital Status
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
Anniversary Date (to be recognized in our monthly bulletin)
*
Street 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
*
Zipcode
ADULT #2:
*
First Name
*
Last Name
Nickname
Hebrew Name (if applicable)
Birthdate
Gender (optional)
Pronouns
Home Phone (if different from above)
Email Address
May we publish you email address in our directory?
yes
no
Cell Phone Number
City
State
*
Zipcode
EMPLOYMENT
INFORMATION
ADULT #1:
Are you employed?
Yes
No
If Employed:
Full Time
Part Time
Occupation:
Business Street Address
City
State
Zipcode
Business Phone Number
May we publish your business phone number in our directory?
Yes
No
Are you retired?
Yes
No
If yes, previous occupation:
ADULT #2:
Are you Employed?
Yes
No
If Employed:
Full Time
Part Time
Occupation:
Business Street Address
City
State
Zipcode
Business Phone Number
May we publish your business phone number in our directory?
Yes
No
Are you retired?
Yes
No
If yes, previous occupation:
Children
Living
In
Your
Home
CHILD #1:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-K
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
CHILD #2:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-k
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
CHILD #3:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-k
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
CHILD #4:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-k
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
CHILD #5:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-k
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
CHILD #6:
Child's Name
Hebrew Name
Gender (optional)
Pronouns
Birthdate
Grade
Pre-k
Kindergarden
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
For new enrollments, please select the tuition and corresponding fees for this child:
Tikvah Explorers (Pre-K & Kindergarten) - Sundays Only $298
1st Grade - Sundays Only $613
2nd Grade - Sundays Only $613
3rd Grade - Sundays and Tuesdays $908
4th Grade - Sundays and Tuesdays $908
5th Grade - Sundays and Tuesdays $908
6th Grade - Sundays and Tuesdays $908
7th Grade - Sundays Only $613
Kesher Teen Program (Select if 8th Grade) $180
Kesher Teen Program (Select if 9th Grade) $180
Kesher Teen Program (Select if 10th Grade) $180
Kesher Teen Program (Select if 11th Grade) $180
Kesher Teen Program (Select if 12th Grade) $180
Materials & Supplies (one fee per child, any grade) $36
Tutoring (Fee to Apply for 6th & 7th Graders) $390
B'nai Mitzvah Fee (Fee applied membership year of b-mitzvah) $225
OTHER
INFORMATION
Are any other family members Congregation Shir Tikvah members?
Yes
No
If yes, please lists names:
Previous Temple Affiliation
How did you become interested in Congregation Shir Tikvah?
Were you referred by Temple Members?
Yes
No
If yes, by whom were you referred?
YAHRZEIT
INFORMATION
Note: At Shir Tikvah yahrzeit letters and bimah readings are limited to immediate family (spouse, sibling, child or parent).
Name
Relationship
To Whom
Which calendar do you prefer to use for this observance date?
English
Hebrew
Name
Relationship
To Whom
Which calendar do you prefer to use for this observance date?
English
Hebrew
Name
Relationship
To Whom
Which calendar do you prefer to use for this observance date?
English
Hebrew
Name
Relationship
To Whom
Which calendar do you prefer to use for this observance date?
English
Hebrew
VOLUNTEER
DATA
Congregation Shir Tikvah relies on volunteers to help make our community the best it can be! Not only is it a MITZVAH to volunteer, it is also a wonderful way to have fun and get to know one another better. We appreciate any amount of volunteering you are able to do!
Please check any of the following skills or interests you have. If and when a need arises for a volunteer with your skills or interests we will contact you for assistance. Thank you!! :
Accounting/Financial
Adult Learning
Advertising
Artistic Ability
Bereavement Skills
Book Club
Bylaws Review/Update
Caring Committee
Computer Skills
Congregational Dinners
Cooking
Baking
Decorating/Interior Design
Disaster Preparedness
Driving Shut-ins
Event Planning
Family Education
Fundraising
Gardening/Landscaping
Grant Writing
Graphic Design
Hebrew
House and Grounds Committee
Interfaith Issues
Issues of Church and State
Leadership Development
Leading Services
Long Range Planning
Website Maintenance
Making Telephone Calls
Membership Committee
Membership Retention
Brotherhood
Mitzvah Day
Musical Ability
Non Profit Board Experience
Office Skills
Office Mailings
Passover Seder
Photography
Preschool
Public Relations
Publicity
Purim Carnival
Reading Torah
Ritual Committee
Sales/Marketing
Sisterhood
Social Action
Teaching Adults
Teaching Children
Temple Archives
Theater/Drama
Ushering
Visiting the Sick
Working on Onegs
Working with Volunteers
Working with College Youth
Writing/Editing
Youth Activities
Temple Leadership Experience? If so, please explain.
Further explanation of any of your skills or interests:
Other skills and interests not listed above:
VOLUNTEER
TIME
COMMITMENT
Day(s) of the week I can volunteer:
Any Day
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time of day I can volunteer:
Any Time
Morning
Afternoon
Evening
Prefer to volunteer on a project basis
Prefer to volunteer on a project basis
PLEDGE
INFORMATION
I/We would like to support Shir Tikvah for the current Fiscal Year with the following pledge:
Please enter an amount of your choosing. You may reference our
Recommended Pledge Guide
for assistance in selecting your pledge amount.
I/We would also like to participate in the Circle of Givers program of extra giving at the following level:
$1,800
$1,080
$720
$360
$180
I/We would like to be recognized in the Schrier for our Circle of Givers gift.
I/We would like to remain anonymous in the Schrier for Circle of Givers gift.
Annual $90 Security Fee
Annual $90 Security Fee
Supports security efforts throughout the membership year.
Thank you for completing this membership application! Please click submit to process your payment for the financial commitments you selected above (monthly installments must be complete by June 30, 2022 - the end of our fiscal year).
Sat, November 2 2024
1 Cheshvan 5785
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Sat, November 2 2024 1 Cheshvan 5785