Membership Application

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Member Details

* Date of Birth

* Gender

* Title

* First Name

Middle Name

* Last Name

Maiden Name (if applicable)

* Personal Email Address

* Mobile Phone

* Your Hebrew Name

KoheinLevi/Yisrael

* Your Father's Hebrew Name

* Your Mother's Hebrew Name

Additional Information

Occupation

Business Name

Business Email

Business Phone

High School Education

Undergraduate Education

Graduate School Education

Family History

* Are there any Conversions or Adoptions in your Family?

If Yes, please share the information with us by uploading any relevant conversion documents below or emailing: jgluska@yisny.org

Please note: All documentation will remain confidential and made available only to the Rabbinic Leadership of YIS

Our community embraces and welcomes Jews of all backgrounds, and we endeavor to ensure that the needs of each of our members are met within the parameters of our sensitive approach to Orthodox Jewish Law and Tradition.

Marital Status

* Marital Status

Spouse Information

* Date of Birth

* Gender

Title

* First Name

Middle Name

* Last Name

Maiden Name (if applicable)

* Personal Email Address

* Mobile Phone

* Spouse Hebrew Name

Tribe

* Spouse's Father's Hebrew Name

* Spouse's Mother's Hebrew Name

Spouse Additional Information

Occupation

Business Name

Business Email

Business Phone

High School Education

Undergraduate Education

Graduate School Education

Spouse Family History

* Are there any Conversions or Adoptions in your Spouse's Family?

If Yes, please share the information with us by uploading any relevant conversion documents below or emailing: jgluska@yisny.org

Please note: All documentation will remain confidential and made available only to the Rabbinic Leadership of YIS

Home Address

Address Line 1

Address Line 2

City

State

Zip

Home Phone

Children

Click the "+" icon to add

* English First Name

* Hebrew Name

* Date of Birth

* Gender

* Lives at Home

* Current School/Yeshiva

N/A if under Kindergarten

* Current Grade

Write "N/A" if under Kindergarten

* Would you like to be added to our grade-specific Youth WhatsApp groups for real-time updates on youth programming?

Yahrzeits

Click the "+" icon to add

* Full Name of Departed

* Hebrew Name

* English Date of Death

* Time (For Yahrzeit)

* Name of Person Observing Yahrzeit

* Departed's Relationship to Person Observing Yahrzeit

Additional Family Information

Please identify special talents (e.g., musical, artistic, tech) that may benefit the community.

Would you be interested in meeting other families with similiar aged children?

YesNo

Would you be interested in sharing a Shabbat meal with a synagogue family?

YesNo

Comments/Questions

Family Photo

Please include a family photo with your membership application so that our Rabbinic team and Executive Board can recognize you and welcome you into the community.

JPG,PNG or PDF files only

Sat, May 17 2025 19 Iyyar 5785

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1313 Weaver Street, Scarsdale, NY 10583

Phone: 914.636.8686

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