Membership Application - Form

6000 Custer Rd. Bldg #9, Plano TX 75023
www.adatchaverim.org ♦ 972.491.5917

Membership Application

*Starred Fields Are Required

* Type of Membership

Primary Adult Member

Title

* First Name

Middle Name

* Last Name

Preferred Name

Personal Pronouns

* Home Address

* City

* State

* Zip Code

* Date of Birth

* Cell Phone Number

* Email Address

Occupation

Employer

Work Address

Work Phone Number

Marital Status

Anniversary Date

* Religious Affiliation

Jewish Affiliation

Hebrew Name

Religion, if not Judaism

Second Adult Member

Title

* First Name

Middle Name

* Last Name

Preferred Name

Personal Pronouns

* Date of Birth

* Cell Phone Number

* Email Address

Occupation

Employer

Work Address

Work Phone Number

* Religious Affiliation

Jewish Affiliation

Hebrew Name

Religion, if not Judaism

Children

How many children do you have?

Child 1 Information

Gender

First Name

Last Name

Nick Name

Hebrew Name

Transliteration (i.e. Jehoshua)

Relationship to Primary Adult

Date of Birth

Public School (Name, Grade)

If College Student, please list address and contact information

Child 2 Information

Gender

First Name

Last Name

Nick Name

Hebrew Name

Relationship to Primary Adult

Date of Birth

Public School (Name, Grade)

If College Student, please list address and contact information

Child 3 Information

Gender

First Name

Last Name

Nick Name

Hebrew Name

Relationship to Primary Adult

Date of Birth

Public School (Name, Grade)

If College Student, please list address and contact information

Child 4 Information

Gender

First Name

Last Name

Nick Name

Hebrew Name

Relationship to Primary Adult

Date of Birth

Public School (Name, Grade)

If College Student, please list address and contact information

Child 5 Information

Gender

First Name

Last Name

Nick Name

Hebrew Name

Relationship to Adult 1

Date of Birth

Public/Secular School

If College Student, please list address and contact information

Optional Yahrzeit Information

A yahrzeit is the anniversary of the day of a loved one's passing. Adat Chaverim will send a yearly reminder prior to the yahrzeit date, according to either the secular or the Hebrew date. If you choose not to do this now, you will always be able to add this information later using your online account.

Would you like us to include Yahrzeits in our database?

YesNo

How many yahrzeits would you like included?

Yahrzeit 1

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship

Relationship (If Other)

Yahrzeit 2

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship

Relationship (If Other)

Yahrzeit 3

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship to You

Relationship (If Other)

Yahrzeit 4

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship

Relationship (If Other)

Yahrzeit 5

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship

Relationship (If Other)

Yahrzeit 6

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship to You

Relationship (If Other)

Yahrzeit 7

Name of Deceased

Please write the name as it should be listed.

Secular Date of Passing

After Sunset?

YesNo

Observed By

Relationship

Relationship (If Other)

Just a few more questions

Any special needs?

Does anyone in your household have any limitations of which we should be aware? Please explain.

Relatives at Adat Chaverim

List any relatives who are members of Adat Chaverim (include name, which member they are related to, and how)

Friends at Adat Chaverim

List any friends who are members of Adat Chaverim.

Is there anything else we should know?

Membership Commitment Level

Adat Chaverim provides many ways to feel the joy of belonging to our community, from our uplifting worship, and educational and family programs to our commitment to Social Justice and Tikkun Olam. This is made possible through the ongoing contributions of our membership. Each household is expected to contribute. Please note that at Adat Chaverim we pride ourselves on our inclusivity and will work with any household where finances create a barrier to membership.

The Membership Commitment Level is the annual pledge each household makes to the congregation. There are several tiers for membership:

Circle Levels make it possible for Adat Chaverim to offer more to our community and be open to all who wish to participate, regardless of financial circumstances. All Circle Levels also include Religious school tuition.
Fair Share Level is the average amount we need from each Adult member in order to meet our current financial obligations and programming needs. Please consider making a commitment at this level if you are able.
Self Selected Level is the amount, if you are unable financially to contribute at the Fair Share level, that you are committing to for the year. Although you may select any amount, a suggested minimum amount is shown.

In order to cover the costs of our ongoing efforts to maintain a safe and secure facility, the Board of Trustees has approved an annual Security Fee of $125 per Adult Member. One hundred percent of these funds will go toward continued police and security presence, additional physical security needs, and any ongoing training for staff and the congregation at large.

Every new member must also commit towards the Capital Fund, which is used towards any enhancements to the current building or the future purchase of property or a building. This commitment is for a total of $3,000, paid quarterly over 5 years beginning in the second year of membership.

For those enrolling children in our Religious School program, there is an additional tuition fee, if not committing at one of the Circle Levels, which is handled through a separate school registration in the spring of each year.

* Commitment Level

* $ Yearly Membership Amount

* Commitment Level

* $ Yearly Membership Amount

Required Security Assessment - $125/year

Required Security Assessment - $250/year

Optional Oneg Donation - $36

$ Total Yearly Commitment

Your total yearly commitment (includes tuition if Circle Level)

I/We apply for membership at Adat Chaverim and agree to be bound by its By-Laws and policies. I/We agree to pay annual membership commitment, Security Assessment, the Capital Fund pledge, and school tuition (if applicable), and any other sums which I/we may owe to the Temple, when due. Membership continues from year to year until I/we submit my/our written resignation or membership is otherwise terminated.

If you have any questions about the Membership Application please contact the temple office at 972-491-5917, or by email at office@adatchaverim.org.

* I have read and agree to the above statement

I have read and agree to the above statement

After you hit submit below, you will be asked to set a password for your account, if you aren't already logged in. After setting a password, or if you are already logged in, you will then be taken to a payment setup screen where you can set up payment information or submit your pledged amount for later payment. You can access your online account later by going to our website (www.adatchaverim.org) and clicking on "Login" ( or "→]" if you're on a cellphone) in the upper right corner, using the Primary Adult email address and the password you selected to log in.

$ Total Yearly Commitment

Your total yearly commitment (includes tuition if Circle Level)