WJC Membership Application

Membership Application

(non-preschool families)

* Membership Type

Primary #1

* First Name

* Last Name

Hebrew Name

* Date of Birth

Address

* City

* State

Zip

* Home Phone #

* Cell Phone #

* Email Address

* Are you Jewish?

Mother's Hebrew Name

Father's Hebrew Name

Tribe (if not known type N/A)

* Occupation

Business Phone #

* Can you read Hebrew?

Primary #2

* First Name

* Last Name

Hebrew Name

* Date of Birth

Address

City

State

* Zip

* Home Phone #

* Cell Phone #

* Email Address

* Are you Jewish?

Mother's Hebrew Name

Father's Hebrew Name

* Tribe (if not known type N/A)

* Occupation

Business Phone #

Can you read Hebrew?

Number of Children

You may enter adult children as well.

*If child was adopted and birth mother was not Jewish, or if either spouse converted to Judaism, please provide conversion documents.

Child #1 Information

First Name

Gender

* Date of Birth

Child's Hebrew Name

* Name of School

* Grade

Child # 2 Information

First Name

Gender

* Date of Birth

Child's Hebrew Name

Name of School

Grade

Child # 3 Information

First Name

Gender

* Date of Birth

Child's Hebrew Name

Name of School

Grade

Child # 4 Information

First Name

Gender

* Date of Birth

Child's Hebrew Name

Name of School

Grade

Please answer a few questions below, we would love to get to know you!

Thank you for joining! What made you decide to join our WJC family?

If you have any relatives that are currently members of the WJC, please list names and relationships:

How did you hear about WJC?

What are you looking for in being a member of the WJC family?

Is there anything you would like us to know about you/your family?

Best way to reach me:

Call meText meEmail me

* Payment Options

You will not be charged at this time.
This is for account setup only.

Please note that once your account is set up, you will receive an email to set up a password and you will be able to view your account, pay your balance, and add Yahrzeits to your account.

Tue, September 27 2022 2 Tishrei 5783