Adult 1(Required)
First
Middle
Last
Pronoun
Adult 2
First
Middle
Last
Pronoun
Contact Information Main Home Address(Required)
Seasonal Home Address
Personal Information Marital Status(Required)
Emergency Contact
Family Record Information
Children Children Use the + to add more lines, as necessary
Yahrzeit Observances Yahrzeits Use the + to add more lines, as necessary
Synagogue Interests Adult 1 Adult 2 Special Talents - Adult 1
Please list any special talents (Torah reading, Haftarah chanting, leading services, singing, playing an instrument, computer use, etc.)
Special Talents - Adult 2
Please list any special talents (Torah reading, Haftarah chanting, leading services, singing, playing an instrument, computer use, etc.)
How did you hear about ICCJ?
Photo Consent and Release This field is hidden when viewing the form
Photo Consent - Fine Print
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Partial Photo Consent - Fine Print
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No Photo Consent - Fine Print
I/we grant to Israel Center of Conservative Judaism (ICCJ) and all subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events.
Subject to the conditions and limitations which I will specify below, I/we grant to Israel Center of Conservative Judaism (ICCJ) and all subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events.
I/we DO NOT grant to Israel Center of Conservative Judaism (ICCJ) or any of its subsidiary groups (Yedidya Academy, Sports Clinic, etc) the right to take photographs of me/us and my/our family in connection with any official ICCJ and partnered functions or events, unless I/we grant explicit permission for that particular photo/video/function/event .DO NOT authorize the ICCJ, its assigns and transferees to use or publish the same in print and/or electronically for purposes including ICCJ's social media (Facebook, Instagram, Youtube, Tiktok, Twitter), website and newsletter.
Photo consent(Required) Please choose an option
Partial photo consent - please specify your preferences:(Required)
I/we understand that mistakes happen. Should I/we notice content including my/our likeness(s) which is not to our liking, we will contact ICCJ and respectfully request that content be removed or edited. I/we understand ICCJ will do its utmost to rectify the situation in a timely manner.(Required)
Consent(Required) By submitting this application, I/we understand that I/we are responsible for all financial obligations that I/we incur with Israel Center of Conservative Judaism. I/we understand that after submitting this form, I/we will be contacted by the office to arrange dues payment.
