Family Record Family Record Today's Date MM slash DD slash YYYY Today's DateFamily Last Name(s) Family Last Name Additional Last Name, if applicable Adult 1Adult 1 Name(Required) Last Name First Name Adult 1 Nickname Nickname, if applicableAdult 1 Birthday MM slash DD slash YYYY Date of BirthAdult 1 Hebrew NamesPlease enter Hebrew names, if known, using English transliteration: Hebrew Name Mother's Hebrew Name Father's Hebrew Name Adult 1 TribePlease select one: Kohen Levi Yisrael Not sure Adult 1 Primary Phone NumberPrimary Phone NumberAdult 1 Primary phone accepts text messagesPrimary phone accepts text messages Yes No Adult 1 Alternate Phone NumberAlternate Phone Number (Optional)Adult 1 Alternate phone accepts text messagesAlternate phone accepts text messages Yes No Adult 1 Email Address Email AddressAdult 1 Prior Congregation Affiliation Prior Congregation AffiliationAdult 1 Occupation OccupationAdult 1 Company CompanyAdult 1 tradition Religious tradition in which you were raisedIs there a second adult?(Required) Yes No Adult 2Adult 2(Required) Last Name First Name Nickname Nickname, if applicableAdult 2 Birthday MM slash DD slash YYYY BirthdayAdult 2 Hebrew namesPlease enter Hebrew names, if known, using English transliteration: Hebrew Name Mother's Hebrew Name Father's Hebrew Name Adult 2 TribePlease select one: Kohen Levi Yisrael Not sure Adult 2 Primary Phone NumberPrimary Phone NumberA2 Primary phone accepts text messagesPrimary phone accepts text messages Yes No Adult 2 Alternate Phone Number Alternate Phone Number Adult 2 Alternate phone accepts text messagesAlternate phone accepts text messages Yes No Adult 2 Email Address Email AddressAdult 2 Prior Congregation Affiliation Prior Congregation AffiliationAdult 2 Occupation OccupationAdult 2 Company CompanyAdult 2 tradition Religious tradition in which you were raisedHousehold InformationMarital Status Single Married Divorced Widowed Other Wedding Anniversary MM slash DD slash YYYY Other Marital Status Home Address Street Address City State / Province / Region ZIP / Postal Code Emergency Contact InformationNameRelationshipPhone Number Add RemoveDo you have a child less than 18 years old? Yes No Enter children's information. Click on the plus sign to add additional children.First NameLast NameHebrew NameBirthdayGenderGrade (if applicable)School (if applicable) Add RemoveDo you have Yahrzeit to add? Yes No Enter Yahrzeit information. Click on the plus sign to add additional Yahrzeits.NameRelationshipRelated toEnglish and/or Hebrew date of death Add RemoveWhich opportunities are you interested in at CBI? (Check all that apply) Preschool Religious School Youth Groups Men's Club Women's Club Finance Committee Fundraising Book Club Office Volunteer Chesed (Comforting) Committee Torah Reading Adult Education Leading Services Membership/Marketing Committee Housing Committee Ritual Committee Comments (optional)
