Affiliation Form - Shir Ami

Mission Statement

Shir Ami is the hub of Reform Judaism in Bucks County, PA. We are dedicated to sustaining and growing a vibrant and diverse Jewish community. We are devoted to educating all who seek a greater understanding of our tradition, practices, and values. We are committed to connecting with each other, cultivating spiritual growth, creating a just and compassionate society, and supporting Israel and our Jewish family worldwide.

Personal Information

* Adult A:

Preferred Pronoun:

* First Name:

* Last Name:

* Home Address:

* City:

* State:

* Zipcode:

* Cell Phone:

* Date of Birth:

* Marital Status:

Date of Marriage (if applicable):

Hebrew Name:

* Religious Background

* Occupation:

Employer:

Business Phone:

Adult B:

Preferred Pronoun:

First Name:

Last Name:

Email:

Cell Phone:

Date of Birth:

Hebrew Name:

Religious Background:

Occupation:

Employer:

Business Phone Number:

Dependent Children:
Family members include single children 30 years old or younger.

Name:

Gender (identifies as):

Hebrew Name:

Date of Birth:

Grade as of Sept. 1

Name:

Gender (identifies as):

Hebrew Name:

Date of Birth:

Grade as of Sept. 1

Name:

Gender (identifies as):

Hebrew Name:

Date of Birth:

Grade as of Sept. 1

Name:

Gender (identifies as):

Hebrew Name:

Date of Birth:

Grade as of Sept. 1

Friends and Family in the Congregation:

Name:

Relationship:

Name:

Relationship:

Name:

Relationship:

Yahrzeit Information:
If you have any questions about Yahrzeit observance, please contact the office at 215-968-3400.

Name of Deceased:

Relationship to whom:

Secular Date (Month/Day/Year)

Preferred Date to Observe:

Name of Deceased:

Relationship to whom:

Secular Date (Month/Day/Year)

Preferred Date to Observe:

Name of Deceased:

Relationship to whom:

Secular Date (Month/Day/Year)

Preferred Date to Observe:

Name of Deceased:

Relationship to whom:

Secular Date (Month/Day/Year)

Preferred Date to Observe:

Prior Synagogue Affiliation and Dates:

Are there any expectations, special needs or concerns you would like to share with us?

Help us connect you to others in our Shir Ami Community. Please indicate your interest in the following synagogue activities.

Are there any skills, talents, or interests you would like to share with us?

What are you looking for from your Jewish Community?

I hereby apply for affiliation at Shir Ami Congregation. I agree to pay the annual affiliation commitment, religious school tuition, building fund and any other assessments as set by the Board of Directors. I agree to abide by the constitution and by laws which are available in the members portal of the website or in the synagogue office. Synagogue affiliation entitles those named on this application to participate in all Shir Ami events, ritual experiences, engagement opportunities, and high holiday services.

I permit Shir Ami to use photographs and videos of myself, and my family members, in Shir Ami's promotional, marketing, program materials and media.I give Shir Ami permission to obtain records from my previous synagogue.

How would you like to receive outreach from the clergy, Shir Ami staff, or congregational lay leaders?

MeetingPhone CallEmail

Is there any additional information you would like to provide?

* Click here to submit this form with $100 New Member Deposit

Click here to submit this form with $100 New Member Deposit*this will be applied to your dues