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Membership Application

Thank you for your interest in becoming a member of Congregation Shaar Hashomayim. Please complete the application below. We will be in touch with you when we receive your submission. Please contact Julie Wiener jwiener@theshaar.org or by phone at 514.937.9474 ext. 189 with any questions.

"*" indicates required fields

Adult One

Title:*

Mr.

Mrs.

Miss

Ms.

Dr.

First Name & Middle Initial:*

Last Name:*

Last Name at Birth (if different):

Address:*

Province/State*

City*

Postal Code*

Email:*

Cell Phone:*

Work Phone:

Home Phone:

Secondary Residence Phone:

Date of Birth:*

Profession:

Tribe

Kohen

Levi

Israel

Hebrew Name (in English):*

Jewish:*

by birth

by conversion

** Please attach conversion certificate

Max. file size: 512 MB.

Date of Bar/Bat Mitzvah:

Did You Attend Day School?

Yes

No

Hebrew Fluency:

Fluent

Moderate

Cannot read Hebrew

Other Jewish Education:

Marital Status*

Date of Marriage:

*GET has been granted/accepted in accordance with Jewish law. Please supply a copy of GET.

Previous synagogue affiliation?

No

Yes

Name of Congregation:

Do you own a cemetery plot?

No

Yes

Location Name:

Mother’s Full Name (English)*

Mother’s Hebrew Name (if known):

Mother Jewish:*

by birth

by conversion**

not Jewish

**If by conversion, please supply copy of certificate.

** Please attach conversion certificate

Max. file size: 512 MB.

Father’s Full Name: (in English)*

Father’s Hebrew Name (if known):

Adult Two

Title Two

Mr.

Mrs.

Miss

Ms.

Dr.

First Name & Middle Initial:

Last Name:

Last Name at Birth (if different):

Email:

Cell Phone:

Work Phone:

Home Phone:

Secondary Residence Phone:

Date of Birth:

Profession:

Untitled

Kohen

Levi

Israel

Hebrew Name (in English):

Jewish:

by birth

by conversion** (please upload certificates below)

File

Max. file size: 512 MB.

Date of Bar/Bat Mitzvah:

Did You Attend Day School?

Yes

No

Do You Read Hebrew?

No

Moderately

Very Well

Other Jewish Education:

Marital Status

*GET has been granted/accepted in accordance with Jewish law. Please supply a copy of GET.

Previous synagogue affiliation?

No

Yes

Name of congregation(s):

Do you own a cemetery plot?

No

Yes

Location Name:

Mother’s Full Name ( in English):

Mother’s Hebrew Name (if known):

Mother Jewish:

by birth

by conversion**

not Jewish

**If by conversion, please supply copy of certificate.

File

Max. file size: 512 MB.

Father’s Full Name (in English):

Father’s Hebrew Name (if known):

Children

Please include both young and adult children.

Number of Children

Child One

Family Name at Birth:

Child Family Name at Birth:

Child

Spouse Family Name at Birth:

Spouse (if applicable)

First Name:

Child First Name:

Child

Spouse First Name:

Spouse (if applicable)

Hebrew Name:

Child Hebrew Name:

Child

Spouse Hebrew Name:

Spouse (if applicable)

Birth Date (month/day/year):

Child Birth Date

Child

Spouse Birth Date

Spouse (if applicable)

Current School:

Child Current School:

Child

Spouse Current School:

Spouse (if applicable)

Bar/Bat Mitzvah Date:

Child Bar/Bat Mitzvah Date:

Child

Spouse Bar/Bat Mitzvah Date:

Spouse (if applicable)

Wedding Date:

Child Wedding Date:

Child

Spouse Wedding Date:

Spouse (if applicable)

Child Two

Family Name at Birth:

Child Two Family Name at Birth:

Child

Spouse Two Family Name at Birth:

Spouse (if applicable)

First Name:

Child Two First Name:

Child

Spouse Two First Name:

Spouse (if applicable)

Hebrew Name:

Child Two Hebrew Name:

Child

Spouse Two Hebrew Name:

Spouse (if applicable)

Birth Date (month/day/year):

Child Two Birth Date:

Child

Spouse Two Birth Date

Spouse (if applicable)

Current School:

Child Two Current School

Child

Spouse Two Current School

Spouse (if applicable)

Bar/Bat Mitzvah Date:

Child Two Bar/Bat Mitzvah Date:

Child

Spouse Two Bar/Bat Mitzvah Date:

Spouse (if applicable)

Wedding Date:

Child Two Wedding Date:

Child

Spouse Two Wedding Date:

Spouse (if applicable)

Child Three

Family Name at Birth:

Child Three Family Name at Birth:

Child

Spouse Three Family Name at Birth:

Spouse (if applicable)

First Name:

Child Three First Name:

Child

Spouse Three First Name:

Spouse (if applicable)

Hebrew Name:

Child Three Hebrew Name:

Child

Spouse Three Hebrew Name:

Spouse (if applicable)

Birth Date (month/day/year):

Child Three Birth Date:

Child

Spouse Three Birth Date

Spouse (if applicable)

Current School:

Child Three Current School

Child

Spouse Three Current School

Spouse (if applicable)

Bar/Bat Mitzvah Date:

Child Three Bar/Bat Mitzvah Date:

Child

Spouse Three Bar/Bat Mitzvah Date:

Spouse (if applicable)

Wedding Date:

Child Three Wedding Date:

Child

Spouse Three Wedding Date:

Spouse (if applicable)

Child Four

Family Name at Birth:

Child Four Family Name at Birth:

Child

Spouse Four Family Name at Birth:

Spouse (if applicable)

First Name:

Child Four First Name:

Child

Spouse Four First Name:

Spouse (if applicable)

Hebrew Name:

Child Four Hebrew Name:

Child

Spouse Four Hebrew Name:

Spouse (if applicable)

Birth Date (month/day/year):

Child Four Birth Date:

Child

Spouse Four Birth Date

Spouse (if applicable)

Current School:

Child Four Current School

Child

Spouse Four Current School

Spouse (if applicable)

Bar/Bat Mitzvah Date:

Child Four Bar/Bat Mitzvah Date:

Child

Spouse Four Bar/Bat Mitzvah Date:

Spouse (if applicable)

Wedding Date:

Child Four Wedding Date:

Child

Spouse Four Wedding Date:

Spouse (if applicable)

Yahrzeit

As a courtesy, we notify members of the yahrzeit of parents, siblings, spouse and children.

Number of yahrzeits I wish to observe:

Person One

Name of Deceased:

Relationship to Member:

Hebrew Date of Death:

English Date of Death:

Hebrew Name in English (include Kohen, Levi or Israel):

Person Two

Name of Deceased:

Relationship to Member:

Hebrew Date of Death:

Hebrew Name in English (include Kohen, Levi or Israel):

English Date of Death:

Person Three

Name of Deceased:

Relationship to Member:

Hebrew Date of Death:

Hebrew Name in English (include Kohen, Levi or Israel):

English Date of Death:

Person Four

Name of Deceased:

Relationship to Member:

Hebrew Date of Death:

Hebrew Name in English (include Kohen, Levi or Israel):

English Date of Death:

Thank you! Todah! Merci!

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450 Kensington Avenue
Westmount, Québec
H3Y 3A2

514.937.9471
info@theshaar.org
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