Hurricane Maria Relief more...

Printed fromJewishPuertoRico.com

ב"ה

Community Partnership

Partnership Form

Community Partnership & Family Information
Thank you for being part of the Chabad Jewish Center of Puerto Rico community.

Please use this form to update your family information and select your community partnership. Your information helps us stay connected and remember important Jewish and family dates.
Your Information
Contact Information
Full Name*
First Name Last Name
E-mail*
Cell Phone*
Occupation
Jewish Information
Hebrew Name*
Father’s Hebrew Name
Mother’s Hebrew Name
Your Birth Date*

Month Day Year
Was the birth after sunset?

YesNoNot Sure
Jewish Status*

Jewish by BirthJewish by Conversion
Tribal Status

KohenLeviYisraelNot Sure
Family Information

Home Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status

Never MarriedMarriedDivorcedWidowed
Spouse Information
Full Name
First Name Last Name
E-mail
Cell Phone
Occupation
Hebrew Name
Father’s Hebrew Name
Mother’s Hebrew Name
Birth Date

Month Day Year
Was the birth after sunset?

YesNoNot Sure
Jewish Status

Jewish by BirthJewish by Conversion
Tribal Status

KohenLeviYisraelNot Sure
Anniversary Date

Month Day Year
Divorce Information
Divorce Date

Month Day Year
Do you have a Jewish Get?

YesNo
Who administered the Get?
Widowed Information
Date Your Spouse Passed Away

Month Day Year
Children
Child 1
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Was the birth after sunset?*

YesNoNot Sure
Gender*

MaleFemale
School*
Add Child?

+ Add Another Child
Child 2
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Gender*

MaleFemale
School*
Add Child?

+ Add Another Child
Child 3
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Gender*

MaleFemale
School*
Add Child?

+ Add Another Child
Child 4
Full Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Gender*

MaleFemale
School*
Add Child?

+ Add Another Child
Additional Information
Are any of your children adopted?

YesNo
Please provide any adoption and/or conversion information relevant to Jewish status.
Additional Family Information
Yahrtzeits
Please add any Yahrtzeits you would like Chabad to keep on record.
Yahrtzeit 1
Name of Deceased*
Hebrew Name*
Father’s Hebrew Name*
Date of Passing

Month Day Year
Was the passing after sunset?

YesNoNot Sure
Relationship to You*
Add Yahrtzeit?

+ Add Another Yahrtzeit
Yahrtzeit 2
Name of Deceased*
Hebrew Name*
Father’s Hebrew Name*
Date of Passing

Month Day Year
Was the passing after sunset?

YesNoNot Sure
Relationship to You*
Add Yahrtzeit?

+ Add Another Yahrtzeit
Yahrtzeit 3
Name of Deceased*
Hebrew Name*
Date of Passing

Month Day Year
Was the passing after sunset?

YesNoNot Sure
Relationship to You*
Add Yahrtzeit?

+ Add Another Yahrtzeit
Yahrtzeit 4
Father’s Hebrew Name*
Name of Deceased*
Hebrew Name*
Date of Passing

Month Day Year
Was the passing after sunset?

YesNoNot Sure
Relationship to You*
Add Yahrtzeit?

+ Add Another Yahrtzeit
Community Partnership
Chabad of Puerto Rico is sustained by the generosity and partnership of our community.

Your partnership helps support Jewish life, programs, services, education, and community resources throughout Puerto Rico.

Please select the partnership level that is right for you and your family.
Select Your Partnership

Family Partnership $1,200 annually · $120 monthlySenior / Single Parent Partnership $990 annually · $90 monthlyChai Partnership $1,800 annually · $180 monthlySilver Partnership $2,600 annually · $260 monthlyGold Partnership $3,600 annually · $360 monthlyDiamond Partnership $5,000 annually · $500 monthlyPlatinum Partnership $18,000 annually · $1,800 monthly
Payment Schedule

AnnualMonthly
High Holiday Seat Donation
Include a High Holiday seat donation?

I would also like to include a High Holiday seat donation.
Adult Seats: $100 each
Child Seats: $25 each
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Paypal

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.