| | Full Name |
Age |
|---|
| Your Name: | |
|
| Other Adult(s): | |
|
| | |
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| Children: | |
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| | |
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| | |
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| | |
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| Address: | |
| City: |
State: Zip Code: |
| Phone: | |
| Email: | |
| I prefer to be contacted by: |
Telephone
Email
Mail by Postal Service
|
| 1. Would you like activities that are: (check all that apply): |
| |
For adults and children (families) |
For yourself only |
| |
For couples only |
For single parent families |
| 2. Would you like activities that include: (check all that apply): |
| |
Shabbatons |
Pot luck dinners |
| |
Holiday celebrations |
Book club |
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Religious study |
Religious observance |
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Gourmet dinners in homes or restaurants |
Visits to plays, movies.. |
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Participating in sports (bowling, skating..) |
Learning, listening, and/or singing Jewish music |
| Other: |
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| 3. How often would you like to meet? |
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Every other week |
Once a month |
| |
Every other month |
On Jewish holidays |
| Other: |
|
| 4. What age range of adults would you prefer? (check all that apply) |
| |
Under 30 |
Over 60 |
| |
30-50 |
No Preference (all ages are okay) |
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40-60 |
| 5. What age range of children would you prefer in your havurah? (check all that apply) |
| |
Infant to 5 years old |
Over 15 years old |
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5-10 years old | No Preference (all ages are okay) |
| |
10-15 years old |
| Any Other Comments: | |
| | |
