2022-23 New Membership Registration and Renewal Form

We are delighted you have chosen to be part of the Emanuel community this year. We welcome all who wish to join us!

If you are interested in a synagogue that prides itself on being open, genuine and inclusive; if you want a place to explore and find your own place as someone - who identifies as a Jew , is in a Jewish family or considering/in the process of becoming a Jew- in the 21st Century; if you're looking for a great group of people who care and support each other, Emanuel is the right community for you.

Welcome to Emanuel Congregation. Please tell us what we can help you with. (Please select One)

New Membership OnlyNew Membership and School Registration

At Emanuel, we allow members to choose their dues for the first two years. Our goal is for members to be at full dues by year three of their membership. To help you select your membership dues amount for this year, below are the full dues numbers. It currently cost Emanuel $3800 per membership to sustain our congregation and we are proud to continue to offer dues relief to those who can not afford their full dues. Therefore, every dollar you can contribute truly helps our community.

Single Young (<36): $500
Young Couple/Family (<36): $1,200
Single Adult / Single Parent Family: $1,750
Couple / Family: $3,300
Senior Single: $1,525
Senior Couple (65+): $2,400

Please note, beginning in year two of your membership, your account will have a Security Fee of $250 and a Building Fee of $300.

Please select the Membership Category that fits your family. (Please select one)

Please enter your dues for Year One of your "Single Young" membership at Emanuel.

Please enter your dues for Year One of your "Young Couple" membership at Emanuel.

Please enter your dues for Year One of your "Single Adult/ Single Parent" membership at Emanuel.

Please enter your dues for Year One of your "Couple / Family" membership at Emanuel.

Please enter your dues for Year One of your "Senior Single" membership at Emanuel.

Please enter your dues for Year One of your "Senior Couple" membership at Emanuel.

How did you hear about us?

Who should we thank?

PERSONAL INFORMATION

Correspondence Email Address

Father's Hebrew Name

Mother's Hebrew Name

Community Involvement

Please indicate any areas of talent/interest by checking the appropriate box or boxes.

Correspondence Email Address

Father's Hebrew Name

Mother's Hebrew Name

Community Involvement

Please indicate any areas of talent/interest by checking the appropriate box or boxes.

Please send all communication to:

Adult 1Adult 2Please opt us out from receiving emails from Emanuel Congregation

Would you be interested in auto-renewing membership at Emanuel?

Yes! I would like to be able to auto-renew for 3 years! (We will contact you about dues for year two and three)Yes! I would like to be able to auto-renew for 5 years! ( We will contact you about the dues amount for years two and three)No thank you! I like being able to renew my membership every year.

How many children will be included in your Membership/Registration?

noneOne ChildTwo ChildrenThree ChildrenFour Children

Please include the names of all your children under the age of 25 as they are included in your membership. Children 26 and older must apply for membership on their own.

Name of School Entering in the Fall

Grade Entering in the Fall

Name of School Entering in the Fall

Grade Entering in the Fall

Name of School Entering in the Fall

Grade Entering in the Fall

Name of School Entering in the Fall

Grade Entering in the Fall

Fund For Emanuel

The Fund for Emanuel is an unrestricted fund. For example, it is not designated for (restricted to) building repairs, travel and transportation, and/or library books.

The Fund for Emanuel is used where funds are needed most. It supports our streaming efforts during servicesa nd events, our growing youth group and teen programming, online speaker series and study groups, social justice initiatives, High Holy Day production, upcoming virtual Share Shabbat, and so much more.

It opens our doors, real and virtual, to all who seek richer, more meaningful lives.

Emanuel Congregation is your neighborhood congregation, wherever you live, and we are grateful you are here.

Please support Emanuel with a gift to our Fund for Emanuel.

Todah Rabah (Thank you)
For additional questions about donations please contact the Emanuel office: 773-561-5173

General Donation to Help the Emanuel Community

I would like to make a gift to Emanuel.

SCHOOL ENROLLMENT INFORMATION

How many children are being enrolled in Emanuel's School Program? (Including High School Students)

SCHOOL FEES

2022-23 School Tuition and Fees:

$400/Student Pre-K to 3rd Grades
$1100/Student 4th to 6th Grades
$900/Student 7th Grade
$500/Student 8th Grade
NO CHARGE for High School (9th-12th Grade)- Monthly meetings at restaurants with Mandy/Cantor. Students pay for their own meals

Important Notes:

Books/Materials included
SIBLING DISCOUNT: -$125 per additional Student beginning with 3rd Child enrolled in school. Emanuel will apply once your membership is submitted.

Grade Entering in the Fall - Student 1

Grade Entering in the Fall - Student 2

Grade Entering in the Fall - Student 3

Grade Entering in the Fall - Student 4

EDUCATIONAL CONSIDERATIONS

In the text box(es) below, please note if your child(ren) receive(s) any education services, such as IEP, Adaptive Equipment, Special Education, Outside Tutoring, Physical / Occupational Therapy, One-on-on Aide*, Behavioral Resource, Gifted/Talented, etc.

DIAGNOSES OR ASSESSMENTS

In the text box(es) below, please note if your child(ren) is/are diagnosed as having, or is being assessed for any of the following: ADHD, Anxiety, Autism Spectrum Disorder, Conduct/Oppositional Disorder, Developmental/Cognitive Delay, Depression, Emotional/Behavioral Disorder, Hearing Disorder, Learning Disability, Obsessive Compulsive Disorder (OCD), Speech/Language Disability, Physical Disability, Cerebral Palsy, Tourette Syndrome, Visual Impairment, Other.

Student 1 OHIP Number

Student 2 OHIP Number

Student 3 OHIP Number

Student 4 OHIP Number

Are student 1 immunizations current?

NoYes

Are student 2 immunizations current?

NoYes

Are student 3 immunizations current?

NoYes

Are student 4 immunizations current?

NoYes

Does student 1 take medication on a regular basis?

NoYes

Does student 2 take medication on a regular basis?

NoYes

Does student 3 take medication on a regular basis?

NoYes

Does student 4 take medication on a regular basis?

NoYes

Does student 1 have a medical condition that could result in a medical emergency?

Does student 2 have a medical condition that could result in a medical emergency?

Does student 3 have a medical condition that could result in a medical emergency?

Does student 4 have a medical condition that could result in a medical emergency?

Student 1 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 2 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 3 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Student 4 - Please enter any additional information regarding medical conditions (please include triggers, severity, and treatment)

Nut Awareness Policy

We have a number of students who suffer from severe nut allergies. Even trace amounts of a problem food can cause a life-threatening allergic reaction.

Please help us maintain a safe community by keeping all nuts and nut products out of the school (peanuts, walnuts, almonds and all other tree nuts). Even those foods labeled with “may contain" or "traces of" in the list of ingredients can be harmful. We appreciate your assistance in making the school safe for every student.

While we strive to be a nut aware facility, we cannot guarantee that your child will not come into contact with products containing nuts. Every reasonable effort will be made to provide a nut aware environment at Emanuel Congregation. Our Staff, members, and students cannot be held responsible. The ultimate responsibility lies with the parents and student to ensure their safety. It is therefore important that if your child has serious allergies, inform us upon registration, and provide any necessary instructions and an EpiPen.

EMERGENCY CONTACT INFORMATION

Please list two people that we may contact in the event we are unable to reach a parent in an emergency.

Who is allowed to pick up your child(ren) from school?

Please enter one or more names of people you authorize to pick up your child(ren) after school.

Emergency Contact 1
First Name

Emergency Contact 1
Last Name

Emergency Contact 1 Relationship

e.g. grandparent, aunt, family friend, etc.

Emergency Contact 1 Phone

Emergency Contact 2
First Name

Emergency Contact
Last Name

Emergency Contact 2 Relationship

e.g. grandparent, aunt, family friend, etc.

Emergency Contact 2 Phone

SCHOOL DISCLAIMER

If we or our emergency contact cannot be reached cannot be reached in the event of a medical emergency, we hereby give permission to the physician or hospital selected by the school or its selected representative, to hospitalize and/or secure proper treatment for our child(ren) named above. We understand that any costs incurred will be our responsibility.

From time to time, limited information about your child(ren) may be disclosed beyond the scope of Emanuel. This may include the release of students' ages, grades, images, artwork, writing or other school related work to the media for publicity, displays, newsletters, etc. If you do not consent to the release of information, you must notify the temple office in writing, prior to the start of the school year.

Subtotal - Tuition and Fees

YARZHEIT INFORMATION

Once your new membership is complete, you will be able to log into Shucloud and add your yarzheit information in the My Account section of the website, which can be found by clicking on your name at the top right of any page on the website. (You will need to be logged in to do this. If you are not logged in, you will see a Login button at the top right of every page.)

If you do not wish to do this online you may contact the temple office to review and update this information.

TOTAL:

Includes Voluntary Community Support, and/or school registration fees.

PLANNED GIVING
Some members select to leave a donation in their Will. These generous contributions are a beautiful and meaningful way to help sustain our community for the next generation. If you are interested in learning more about this or plan to add Emanuel in your estate planning, please check the appropriative boxes below.

I will include Emanuel in my estate planning.

I would like more information on how ways to include Emanuel in my will or estate

ADMINISTRATION

On the next page you will be presented with payment options.

You can set up a single payment or divide it into monthly payments (up to 10 months beginning in July and ending in April).

Important note:

All credit card payments have a 3% convenience fee per charge
ACH (e-check) payments have no convenience fee
Very Important: Before you submit payment, check the date the payments begin. If you select multiple payments, you can set it to begin July 1, 2022 - the beginning of the new membership year.

Adult 1 Information

Adult 2 Information

Child 1

Child 2

Child 3

Child 4

2022-23 School Tuition and Fees: