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2024-2025 Membership Commitment Renewal Form

We are delighted you have chosen to be part of the Emanuel community for another year (and hopefully many more). 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. 

 

 

Below is a list of our membership commitments for the new fiscal year. It currently cost Emanuel $4,600 per membership to sustain our congregation, and we are proud to continue to offer dues relief to those who cannot afford their full dues. Therefore, every dollar you can contribute truly helps our community. If you would like to help a member/family that is unable to pay full dues, please take a moment to complete the Benefactor section of this renewal form. 
 
  • Young Single (<36): $750
  • Young Couple (<36): $1,500
  • Single Adult / Single Parent Family: $2,000
  • Couple / Family: $3,600
  • Senior Single (65+): $1,700
  • Senior Couple (65+): $2,650

Please note, your account will have an added Security Fee of $350 and a Building Fee of $300 ($150 for members who have been part of Emanuel for over 5 consecutive years).
This is an additional fee to help Emanuel maintain the building and grounds.
This is an additional fee to help Emanuel maintain security measures to keep our community safe.



PERSONAL INFORMATION

Adult 1 Information

Community Involvement

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

Adult 2 Information

Community Involvement

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


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.

Child 1

Child 2

Child 3

Child 4


Fund For Emanuel

The Fund for Emanuel is an unrestricted fund. For example, it is not designated for (or 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 services and events, our growing youth group and teen programming, online speaker series and study groups, social justice initiatives, High Holy Day production 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

Thank you & todah rabah
For additional questions about donations please contact the Emanuel office: 773-561-5173

I would like to make a gift to Emanuel.
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.
MEDICAL INFORMATION
Family Publicity Permission
By clicking yes, you are agreeing that Student's photograph, name, art, written work, voice or verbal statements may appear in Emanuel Congregation publicity or publications.
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.

Please enter one or more names of people you authorize to pick up your child(ren) after school.
e.g. grandparent, aunt, family friend, etc.
e.g. grandparent, aunt, family friend, etc.
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.
 



YAHRZEIT INFORMATION


You may verify your yahrzeit 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.


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 appropriate boxes below.                                          

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 notes:

  • All credit card payments have a 3% convenience fee per charge.
  • ACH (e-check) payments have no convenience fee.
  • Before you submit payment, check the date the payments begin. If you select multiple payments, you can set it to begin July 1, 2024 - the beginning of the new membership year.

Please click the 'Save and Continue' button below.

Wed, November 13 2024 12 Cheshvan 5785