Membership Registration 2020-2021 - Form - University Synagogue (Los Angeles)

Shalom. We are excited that you are interested in being a member of the University Synagogue community. Please complete the form below to finalize your membership. If you have any questions or concerns please contact Toby Berkow, Executive Director at tberkow@unisyn.org.

* Is your family new to University Synagogue?

Family Contact Information

* Title

* First Name (Primary)

* Last Name (Primary)

* Birthday (Primary)

* Email (Primary)

* Phone (Primary)

* Occupation & Employer

* Street Address (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

If there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first.

* Date Married

* Title

* First Name (Secondary)

* Last Name (Secondary)

* Birthday (Secondary) (MM/DD/YYYY):

* Email (Secondary)

* Phone (Secondary)

* Occupation & Employer

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

* How many children in your household?

Child 1 Information

* Child 1 First Name

* Child 1 Last Name

Child 1 Nickname (if applicable)

* Child 1 Hebrew Name

* Child 1 Birthdate

* Gender Identity

If Other, please indicate preferred pronouns

* Are you enrolling child 1 in ECLC (Preschool) or Religious School?

Please Select OneYesNoSelecting "Yes" does not enroll your child, you will receive the correct school enrollment, registration, and payment information will be available to complete in your online member portal at the submission of this form.

* Is child 1 a new student?

Please Select OneYesNo

Child 2 Information

* Student 2 First Name

* Student 2 Last Name

Student 2 Nickname (if applicable)

* Student 2 Hebrew Name

* Student 2 Birthdate

* Gender Identity

If Other, please indicate preferred pronouns

* Are you enrolling child 2 in ECLC (Preschool) or Religious School?

* Is child 2 a new student?

Please Select OneYesNo

Child 3 Information

* Student 3 First Name

* Student 3 Last Name

Student 3 Nickname (if applicable)

* Student 3 Hebrew Name

* Student 3 Birthdate

* Gender Identity

If Other, please indicate preferred pronouns

* Are you enrolling child 3 in ECLC (Preschool) or Religious School?

* Is child 3 a new student?

Please Select OneYesNo

Child 4 Information

* Student 4 First Name

* Student 4 Last Name

Student 4 Nickname (if applicable)

* Student 4 Hebrew Name

* Student 4 Birthdate

* Gender Identity

If Other, please indicate preferred pronouns

* Are you enrolling child 4 in ECLC (Preschool) or Religious School?

* Is child 4 a new student?

Please Select OneYesNo

Media Release

From time to time members of your household photo may be taken in our classrooms or special events. We use these photos in the synagogue newsletter (the Torch), on our synagogue display boards, the University Synagogue website as well as Facebook groups and other publicity materials.

* I give my permission for photos to be used:

Congregation Community

You may have noticed that at the top of the form we begin with family information. This is intentional. When you come in the building and spend time learning and volunteering with us, you make a powerful statement to your child(ren) that Jewish life is a process and that we are all on the same team in creating these experiences for them. Don’t underestimate the subtle power of this statement!

We have opportunities during the course of the year on which families can engage in various ways based on Interest Groups.

Please selected as many of these Interest Groups your family would like to participate in:

Ongoing Volunteer Opportunities (check all that apply)

Greeter/UsherTikkun Olam/Social JusticeMitzvah Corps

Any other skills or talents you might be willing to share?

Membership Rates

Standard Membership levels include: full access to our Jewish community; with access to clergy for life cycle events, eligibility for participation in our Early Childhood Learning Center, Religious School and B’nei Mitzvah program, 2 High Holy Day tickets, and our various programs and services throughout the year.

Pillar Membership levels, are our enhanced memberships that help ensure the highest quality of programming and service to our congregation. These memberships also make it possible for the Synagogue to extend membership and scholarships to those needing financial assistance.

Facilities Maintenance Fund - $300

Facilities Maintenance Fund - $300The Facilities Maintenance Fund (FMF) is a mandatory contribution for the first 5 years of your membership. After that time, it is voluntary. The FMF helps to support ongoing maintenance and replacement of essential building needs such as our roof, mechanical equipment and the like. We ask that you consider continuing your ongoing support of this Fund past your initial 5 years of membership.

* Security - $500

Security - $500This is required by all families.

ARZA - $50

ARZA - $50ARZA, the Association of Reform Zionists of America, is the Zionist arm and voice of the Reform Movement, serving 1.8 million Reform Jews in North America.

Voluntary Additional Dues

* There are many impediments to Jewish practice, but finances should never be one! We ask that every family commits to some financial contribution; however, we are very happy to discuss financial aid options for any family who needs it. If you select yes, you will discuss your payment ability in a confidential meeting with a member of University Synagogue's staff.

By typing my name below, I/we agree and understand that I am (we are) responsible for the agreed upon dues for the year of July 1, 2020 - June 30, 2021, and understand that due to necessary salary planning and budgeting for the year, the Synagogue does not prorate or offer refunds for dues, fees or tuition. I/we also agree that I/we must remain a member(s) in good standing, having fulfilled all financial commitments to University Synagogue in order to receive services including school attendance, High Holy Day tickets, and/or maintaining B’nei Mitzvah dates. Should events beyond the control of University Synagogue, including, but not limited to, any fire, act of God, hurricane, tornado, flood, extreme inclement weather, explosion, war (including armed conflict), governmental action, act of terrorism, risk of infectious disease, epidemic, pandemic, shortage or disruption of necessary utilities (water, electricity, etc.), or any other event beyond University Synagogue’s control, occur, University Synagogue has the discretion to close University Synagogue and/or modify its curriculum, schedules, length of school day, length of school year, and/or means of learning and teaching methods. The Member’s financial obligations under this Contract remain in full force and effect. Should University Synagogue close, University Synagogue’s duties and obligations under this agreement shall be suspended immediately without notice until such time as University Synagogue, in its sole and reasonable discretion, may safely reopen. If University Synagogue cannot reopen due to a force majeure event under this Paragraph, University Synagogue is under no obligation to refund any portion of any fees, deposits, tuition, or other amounts paid.

*By typing my name, I confirm I have read, understand and agree to the above.

Total Dues Commitment Amount