KAM Isaiah Israel New Member Form

Welcome to KAM Isaiah Israel!
KAM Isaiah Israel welcomes everyone as members. Please use this form to provide us with some information about you and your family to help us get your member account set up and pledge your dues. Your dues commitment at any level makes all of our programming and events possible! Please call 773.924.1234 or email kamii@kamii.org if you have any general questions about using this form or making your dues commitment.

Household Information

Adult #1

Title (Dr, Rabbi...)

* First Name

* Last Name

Suffix

Nickname or Preferred Name

Please let us know if you have a name you prefer to go by if not already listed as First name.

Preferred Pronouns

If you would like to provide us with your preferred pronouns, please do so here. This is not a required field.

* Email Address

Mobile Number

Date of Birth

We use this information to acknwoledge and celebrate milestone birthdays with you.

Religious/Worldview Identity

Hebrew Name (If Applicable):

Adult #2
(if applicable)

Title (Dr, Rabbi...)

First Name

Last Name

Suffix

Nickname or Preferred name

Please let us know if you have a name you prefer to go by if not already listed as First name.

Preferred Pronouns

If you would like to provide us with your preferred pronouns, please do so here. This is not a required field!

Email address

Mobile Number

Date of Birth

We use this information to acknwoledge and celebrate milestone birthdays with you.

Religious/Worldview Identity

Hebrew Name (If Applicable)

* Street Address

Unit No./ PO Box/ Etc.

* City

* State

* Zip Code

* Primary Phone

Wedding Anniversary Date (If Applicable)

How did you hear about KAM Isaiah Israel?

Why have you decided to join the synagogue?

Child Information
(if applicable)

Please provide the following information (where applicable) for each child in your family:

Full name
Nickname
Hebrew name
Birth date
School grade (as of September 2023)
School name

Yahrzeits to be Remembered
(if applicable)

Please provide the following information about the Yahrzeits your family remembers:

Full name of deceased
Date of death (Gregorian calendar)
After or before sunset (Used to calculate Hebrew calendar date)
Person to be notified
Relationship to the deceased
Wish to observe Yahrzeit by Hebrew or Gregorian calendar

Shoresh Enrollment

Click here or contact Director of Lifelong Learning, Deanna Neil, for more information about Shoresh, our Shabbat-based religious school program for Kindergarten-10th grade learners.

* Are you enrolling child(ren) in Shoresh?

Please fill out the fields below for the learner(s) you are enrolling. Our Religious School Director will contact you to welcome you, get any additional information needed, and follow up about tuition.

* Learner 1 first name, 2023-24 grade, and weekday school

What should we know about this learner that may affect their learning experience at Shoresh?

This may include learning differences, emotional or family issues, food restrictions or allergies, etc. The Religious School Director will follow up to discuss ways we can help your child thrive.

What accommodations does this child receive at their weekday school?

Learner 2 first name, 2023-24 grade, and weekday school

What should we know about this learner that may affect their learning experience at Shoresh?

This may include learning differences, emotional or family issues, food restrictions or allergies, etc. The Religious School Director will follow up to discuss ways we can help your child thrive.

What accommodations does this child receive at their weekday school?

Learner 3 first name, 2023-24 grade, and weekday school

What should we know about this learner that may affect their learning experience at Shoresh?

This may include learning differences, emotional or family issues, food restrictions or allergies, etc. The Religious School Director will follow up to discuss ways we can help your child thrive.

What accommodations does this child receive at their weekday school?

* Emergency Contact: Non-parent name, Cell phone, Relationship to child(ren)

In case of injury or illness, every effort will be made to contact the parent(s)/guardian(s). Please provide an additional contact in the event that the parent(s)/guardian(s) cannot be reached

* Brit Kavod

A brit ("breet") is a covenant. We ask Shoresh parents to read through this document and enter into a brit, a covenant, with their child(ren), with other families, and with our Shoresh community to bring kavod (respect) and shalom (peace) to Shoresh each week.

Please read the text of the Brit Kavod and enter your name here. By typing your name, you agree to enter in to this brit ("breet"), this covenant, with Shoresh during the 2023-24 school year.

* Release form

In the event that we/I cannot be reached in an emergency, I/we authorize a KAM Isaiah Israel representative to seek medical attention for my child(ren).
I give permission for photos and videos of my child(ren) to be used for publicity purposes, including but not limited to KAM Isaiah Israel emails, website, and social media. If there are limitations to this permission for my child(ren) I will notify KAM Isaiah Israel in writing before the Shoresh year.
I give permission for learning sessions to be recorded for the purposes of observation and supervision for Shoresh teachers. Recordings will be used exclusively by KAM Isaiah Israel and Shoresh staff and teachers to review and will not be distributed beyond the faculty. Recordings will be deleted after use for teacher observation.
The above child(ren) has/have permission to participate in all class field trips during the 2023 - 2024 school year. I will be notified in advance of all trips. I will notify the school in writing if my child(ren) is/are unable to participate.
I release KAM Isaiah Israel Congregation, its trustees, officers, employees, agents, and all other persons participating in our chaperoning such field trip from all claims which I or my children may have for personal injuries (or emergency medical care related to such injuries), known or unknown, which my children may incur by participating in such activity.

By typing your name, you agree to these terms during the 2023-24 school year.

Membership Dues Commitment

Please choose one option from the dues commitment levels provided below. Those seeking all the privileges of membership should choose either a Standard or Enhanced Commitment Level. Membership includes access to clergy for counsel and lifecycle events, tickets to High Holy Day services, discounts for renting space in the building and more.

Standard Membership Levels include access to the discounted member rate for Shoresh (religious school) tuition.
- Partner: $2,250
- Sustainer: $3,600
- Sponsor: $5,500
- Requesting Adjusted Dues

Enhanced Membership Levels include full Shoresh (religious school) tuition for all children in the immediate household. Fees are not included.
- Advocate: $8,500 and higher
- Builder: $15,000 and higher
- Visionary: $25,000 and higher

If you have any questions about which commitment level is right for you, please reach out to Cody Gierat, Operations Manager, cgierat@kamii.org or 773.924.1234.

Non-member options include:

Student: $18. Select if you are full-time student and would still like to participate in our community beyond just coming to High Holy Day services.
KAMII Supporter: $360. Select this option if you belong predominantly to another synagogue or live out of state and would still like to support the KAMII community.

Enter dues commitment in the box below

Please type in your dues commitment for the year (note that our fiscal year starts July 1 and ends on June 30), based on the dues commitment level you choose from the list above. For example, if you choose "Sustainer ($3600)," type in $3,600. If you choose "Builder," type in an amount between $8,500 and 14,999.

If you choose "Request for Adjusted Dues," please type in the amount that works for your budget.

After submitting this form, you will be prompted to make payment arrangements for your dues commitment. Dues can be paid in full or broken into multiple payments over the course of the next year, using credit card, electronic check, or billing your account to pay by standard check.

If you would like to make a donation in addition to your dues, please write the amount in the box below.

Donation information (i.e., in honor/memory of, etc.)

Total 2023-2024 Pledge

How would you like to receive your monthly billing statements? (Email or Paper Mail)

Alternate Billing Address (if you wish to receive your billing statements at a different address than the primary address listed at the top of this form)

If your mailing address is different than your primary address listed above, please provide it here.

* I have reviewed all of the information and confirm that it is correct

I have reviewed all of the information and confirm that it is correct