New Member Application 25-26

Congregation Dor Hadash
New Member Application

2025-2026

Please select the number of adults in your household

1 Adult2 Adults

ADULT 1

* First name

* Last name

* Email

* Cell Phone

Birthday

Occupation

Place of Employment

Preferred Gender/Pronouns

Preferred Gender/Pronouns:

Anything else you'd like us to know about Adult 1?

Are you Jewish?

Hebrew Name

ADULT 2

First name

Last name

Cell Phone

Birthday

Occupation

Place of Employment

Marital Status?

Anniversary

Preferred Gender/Pronouns

Preferred Gender/Pronouns if not listed

Anything else you'd like us to know about Adult 2?

Are you Jewish?

Hebrew Name

HOUSEHOLD ADDRESS

* Street

* City

* State

* Zip

Check this box if you DO NOT want contact information to be shared confidentially among our members

CHILDREN

As a community we are excited to welcome your entire family to Dor Hadash, including both dependent and adult children.

Number of dependent children (26 and under)

CHILD #1

Child 1 Full Name

Child #1 DOB

Child #1 Pronouns

Child #1 Grade (Fall 2025)

Child #1 Special skills or hobbies

What else would you like to share about Child #1?

Will Child #1 Enroll in Gesher?

Child #1 Allergies or Medical Conditions:

Child #1: Special learning needs or support provided by regular school

CHILD #2

Child 2 Full Name

Child #2 DOB

Child #2 Pronouns

Child #2 Grade (Fall 2025)

Child #2 Special skills or hobbies

What else would you like to share about Child #2?

Will Child #2 Enroll in Gesher?

Child #2 Allergies or Medical Conditions:

Child #2: Special learning needs or support provided by regular school

CHILD #3

Child #3 Full Name

Child #3 DOB

Child #3 Pronouns

Child #3 Grade (Fall 2025)

Child #3 Special skills or hobbies

What else would you like to share about Child #3?

Will Child #3 Enroll in Gesher?

Child #3 Allergies or Medical Conditions:

Child #3: Special learning needs or support provided by regular school

Do you have non dependent children (27 and over)?

Please enter a name and birthdate for any children age 27 and older as well as any other relevent details such as location, marital status, etc.

* Name of Emergency Contact

* Phone number of Emergency Contact

Child Medical and Photo Release
Please check the boxes below indicating you have read and agree to the following releases.

I confirm that my minor children have been entrusted into the care of a representative of Congregation Dor Hadash for the welfare of that minor, and authorize this representative to consent to emergency medical treatment in the event that I am/we are unable to be contacted. A copy of this release is to be considered valid authorization to perform emergency medical treatment. This authorization is effective until July 1, 2026, unless revoked at any time by written notice.

I agree to (1) pay the annual Gesher tuition to CDH during the fiscal year July 1, 2025-June 30, 2026, with an initial payment due on July 15, 2025 and (2) in the event of early withdrawal from the Gesher program, to be responsible for any fees outstanding at the time of that withdrawal.

I/we grant a release for photographs of our child(ren) taken while participating at CDH to be published in HaKesher, on the website, or as part of a publicity release to the press.

Please enter your name below

Date

ANNUAL CONTRIBUTION 2025-2026

New members are offered the option of paying as little as 50% dues in the first year of membership.
New members enrolling children in Gesher have the option of free membership for the first year, with paid Gesher fees.

* Membership Categories and Dues

*No payment will be due today. If you are unable to meet the standard dues commitment and would like to make an arrangement with Congregation Dor Hadash, please choose the option that best describes your household. No funds will be due today and the charge can be adjusted per your arrangement.

* By checking this box you indicate your agreement to pay $40.00 Reconstructionist Dues for 2025-26

By checking this box you indicate your agreement to pay $40.00 Reconstructionist Dues for 2025-26

Yahrzeit Information

If you would like to add additional yahrzeits, or complete this seciton at another time, please email the information to our admin, Eliana at administrator1@dorhadash.org. Once your account has been setup you can also add yahrzeits from your homepage.

Full Name of Deceased

Relationship (mother of member 1)

Date of Passing

Full Name of Deceased

Relationship

Date of Passing

Full Name of Deceased

Relationship

Date of Passing

Are you or an immediate family member serving in the Armed Forces?

NoYes, I serve in the Armed ForcesYes, an immediate family member is serving in the Armed Forces

Name of family member in service

Relationship to Member

Hebrew Comprehension

Reading Prayer BooksChanting TorahAble to speak and understand a moderate amountFluent in speech and readingIf you can read/speak Hebrew, please check all boxes that apply to you.

Total Display

No payment is due today. Once your form is submitted, we will reach out to you to go over membership and set up your payment. Thank you for your interest in Dor Hadash!

ADULT 1

ADULT 2

HOUSEHOLD ADDRESS

CHILDREN

Yahrzeit Information

No payment is due today. Once your form is submitted, we will reach out to you to go over membership and set up your payment. Thank you for your interest in Dor Hadash!

Congregation Dor Hadash | 4126 Executive Drive | La Jolla, CA 92037 760.209.6609 | dorhadash.org

Congregation Dor Hadash | 4126 Executive Drive | La Jolla, CA 92037
760.209.6609 | dorhadash.org