Family Profile for CRC

Household Information

Please help us keep your information current and accurate in our systems by completing the below information if anything *has changed.* If you prefer to be thorough, feel free to complete the entire form. (Take care to check for typos, especially in names and email addresses.)

If you have questions, contact Nancy@centralreform.org or Ezra@centralreform.org.

Household Contact Information

Name (Your Name, or Household Name)

Primary Address

Secondary Address

Primary Phone Number

Secondary Phone Number

Primary Fax Number

Member Since

Information for Adults in the Household

Complete the below form for each adult in the household. If there are additional adults to enter information for, click the turquoise link at the bottom right hand side that says "Add Information for Another Adult." You may continue to enter information for as many adults are in your household.

English Name

Birth Date

Email Address

Cell Phone

Below you may enter this person's pronouns. (Learn more.) You may select multiple from the list on the left; if the right pronouns are not shown, type them in the box on the right.

Pronouns

Additional Pronouns

Occupation Information

Employer

Occupation

Business Address

Business Phone

Business Email

Business Fax

Hebrew Name (if applicable)

Wedding Anniversary (if applicable)

If there are additional adults in your household, such as partners or extended family under the same roof, click the turquoise link below here to the right ("Add Information for Another Adult") to enter information for them. If there are no other adults, click the purple button that says "Next Page."

Information about Children

Do you have information to enter for children in your household?

YesNo

Information about Yahrzeits

Are there yahrzeits you would like to enter information for? These yahrzeits are shared annually in our newsletters and by our rabbis in services.

Yes, I have yahrzeits I would like to share.No, I would not like to enter yahrzeit information at this time.

Yahrzeit Information

Complete the below form for each yahrzeit. These yahrzeits are shared annually in our newsletters and by our rabbis in services.

If there are multiple yahrzeits to enter information for, click the turquoise link at the bottom right hand side that says "Add Information for Another Yahrzeit." You may continue to enter information for as many yahrzeits are in your household.

Name of the Deceased

Relationship to You

Do you prefer to observe the yahrzeit on the English date or the Hebrew date? (If no preference, we will default to the English date in our communications.)

English DateHebrew DateNo preference

English Date of Death

Hebrew Date of Death (if known)

If you do not know the Hebrew date of death, did they die after sunset?

Yes, after sunsetNo, before sunsetI don't know

Cemetery Where Buried (If Known)

If there are additional yahrzeits to enter information for, click the turquoise link below here to the right ("Add Information for Another Yahrzeit") to enter information for them. If there are no other yahrzeits, click the purple button that says "Submit."