Havurah Interest Form

Adult 1 Information

First Name *

Last Name *

Email Address *

Cell Phone

Work Phone

Occupation

Adult 2 Information (if applicable)

First Name

Last Name

Email Address

Cell Phone

Work Phone

Occupation

Are there other adults living in your household? If so please list them and describe their relationship to your family:

Additional Information

Home Phone *

When did you join Temple Isaiah?
*

Street Address *

City *

State *

Zip Code *

Child Information (if applicable)

	Name	Birth Date	Gender
1	Name	Birth Date	Gender
2	Name	Birth Date	Gender
3	Name	Birth Date	Gender
4	Name	Birth Date	Gender
5	Name	Birth Date	Gender

Please indicate how important the following should be in your Havurah: *

	Very Important	Somewhat Important	Not Very Important
Celebrating Jewish Holidays	Very Important	Somewhat Important	Not Very Important
Socializing	Very Important	Somewhat Important	Not Very Important
Interfaith/Multifaith Families	Very Important	Somewhat Important	Not Very Important
Study/Discussions	Very Important	Somewhat Important	Not Very Important
Social Action/Tzedakah	Very Important	Somewhat Important	Not Very Important
Cultural Activities	Very Important	Somewhat Important	Not Very Important
Outdoor Activities	Very Important	Somewhat Important	Not Very Important
Food/Wine	Very Important	Somewhat Important	Not Very Important

Are you interested in joining a "Special Interest" Havurah?
*

	Yes	No
Book Club	Yes	No
Torah Study	Yes	No
Softball Team	Yes	No
Biking	Yes	No

Other:

Are you interested in starting a "Special Interest" Havurah? If so, please describe?

Please share any other information that would help us do our best to find the right match for you:

If you would prefer to be in a Havurah with other specific Temple Isaiah families, please identify them below (please note that matches must be mutually requested):

Each Havurah has a Representative who acts, on a rotating basis, as the point of contact between the Havurah and the Havurah Coordinator. The initial Representative of the Havurah is also responsible for contacting the other members of the Havurah and organizing the first meeting. Havurah Representatives rotate periodically.

Are you able to be your Havurah's contact person? *

Yes

No