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* Name

First, Middle, Last

Hebrew Name

If applicable

Gender Identity

* Email

Birthdate

* Mobile Phone

Work Phone

Home Phone

Occupation

Second Adult

Name

First, Middle, Last

Hebrew Name

if applicable

Gender Identity

Birthdate

Mobile Phone

Work Phone

Occupation

Household Information

* Street Address

* City & Zip Code

Neighborhood

If you live in an HOA or named community, let us know

Marital Status

Wedding Anniversary

(If applicable) Month, Day & Year

Prior Synagogue Affiliation

Dates of Affiliation

Emergency Contact

If you would like the Temple to notify a relative in the event of an emergency please provide their name and phone number

Emergency Name & Phone

Children in Household

Child 1

Name

Birthdate

Hebrew Name

Gender Identity

Name of current secular school and grade

Child 2

Name

Birthdate

Hebrew Name

Gender Identity

Name of current secular school and grade

Child 3

Name

Birthdate

Hebrew Name

Gender Identity

Name of current secular school and grade

Child 4

Name

Birthdate

Hebrew Name

Gender Identity

Name of current secular school and grade

Membership

I would like to take advantage of the new member rates for the 1st two years

* My Membership Category is

Single

Senior Single

Family

Senior Family

Membership in our Brotherhood and Women of TKT auxiliary groups is complimentary for your first year and $36 annually after that.

Select

Yes, I'd like to join Brotherhood this year

Yes, I'd like to join Women of TKT this year

School Enrollment

I would like to take advantage of the new member tuition rates for the 1st two years

Current / New Member Rates
Early learners $215 / $650
Grades K-7 $231 / $700
KTTY Grades 8-12 $83 / $250

Number of enrolled Early Learners

potty-trained - Age 3 to the end of preschool

Number of enrolled students for Grades K-7

Number students enrolled in KTTY Grades 8-12

Additional Fees

Annual Security Fee $125

* Building Fund

Pay in 5 annual Installments of $200.00

Pay full amount $1,000.00

Forgo fund till 3rd year if accepting new member rate

I have already contributed to the building fund at my former temple $0.00

I would like to make an additional one-time donation of

As a member of Temple Kol Tikvah, I understand that I am making a full year financial commitment to support the congregation. Additionally, I understand that Temple Kol Tikvah depends upon this commitment, and I will fulfill my financial obligation on or before June 30th of this coming year. If I am unable to do so, I agree to contact Temple Kol Tikvah to make alternative arrangements.

* Please enter your name as an electronic signature

IMPORTANT NOTICE: Pledges must be current to receive High Holiday tickets.