Chavurah Program

Chavurah Inquiry

• Adult Name*

  First Last

• Adult's Email address*

• Second Adult Name (optional)

  First Last

• Second Adult's Email address*

• First Child's Name (optional)

  First Last

• Child's Gender
  • Male
  • Female
• Child's Age

  Please enter a value between 0 and 120.

• Second Child's Name (optional)

  First Last

• Child's Gender
  • Male
  • Female
• Child's Age

  Please enter a value between 0 and 120.

• Third Child's Name (optional)

  First Last

• Child's Gender
  • Male
  • Female
• Child's Age

  Please enter a value between 0 and 120.

• Fourth Child's Name (optional)

  First Last

• Child's Gender
  • Male
  • Female
• Child's Age

  Please enter a value between 0 and 120.

• Address

  Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP Code

• Phone Number

• I/We would like a chavurah composed of:*

  (check all that apply)

  •  Family - including children in ALL activities
  •  Family - including children in SOME activities
  •  Adults
  •  Women only
  •  Men Only
• If appropriate groups are possible, would you want to participate in two different types of chavurot?
  • Yes
  • No
• Family Oriented*

  Indicate your level of interest in this type of activity:

  Very ImportantImportantSomewhat ImportantNot Important
• Social and Cultural*

  Indicate your level of interest in this type of activity:

  Very ImportantImportantSomewhat ImportantNot Important
• Study and Discussion*

  Indicate your level of interest in this type of activity:

  Very ImportantImportantSomewhat ImportantNot Important
• Shabbat and Holiday Observance*

  Indicate your level of interest in this type of activity:

  Very ImportantImportantSomewhat ImportantNot Important
• Do you prefer a close match in age and/or gender to your own child(ren)?
  • Age
  • Gender
  • Both

• Is there anything else you'd like us to know or use in the matching process?

  (such as interfaith family, gay/lesbian individuals or families, Hebrew speaking, special needs, have no local extended family, etc.)