Printed from Chabadofcleveland.com

Family Information Form

Family Information Form

FAMILY INFORMATION FORM

 

HUSBAND INFORMATION

Title:       First Name:       Last Name: 

Home Phone:       Work Phone:       Cell Phone: 

Fax:       E-Mail Address: 

Street Address: 

City:       State:       Zip Code: 

Hebrew Name:         Cohen      Levi      Israel

Father's Hebrew Name:       Mother's Hebrew Name: 

Bar Mitzvah Torah Portion:         Please check if you can read Haftorah

Hebrew Birthday:       Click here for your Hebrew Birthday

English Birth Date:      Day     After Nightfall

Occupation: 

 

WIFE INFORMATION

Title:       First Name:       Last Name: 

Home Phone:       Work Phone:       Cell Phone: 

Fax:       E-Mail Address: 

Hebrew Name: 

Father's Hebrew Name:       Mother's Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:       Day     After Nightfall

Date of Marriage:    Occupation: 

 

CHILDREN'S INFORMATION

Child's Name:       Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:      Day     After Nightfall

 

Child's Name:       Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:      Day     After Nightfall

 

Child's Name:       Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:       Day     After Nightfall

 

Child's Name:       Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:      Day     After Nightfall

 

Child's Name:       Hebrew Name: 

Hebrew Birthday:        Click here for your Hebrew Birthday

English Birth Date:      Day     After Nightfall

For additional children, please use this box to fill in the above mentioned information

 

 

YAHRTZEIT INFORMATION

English Name of the Deceased: 

Full Hebrew Name:       Relationship: 

Hebrew Date of Passing: 

Civil date:        Day    After Nightfall

 

English Name of the Deceased: 

Full Hebrew Name:       Relationship: 

Hebrew Date of Passing: 

Civil date:       Day    After Nightfall

 

English Name of the Deceased: 

Full Hebrew Name:       Relationship: 

Hebrew Date of Passing: 

Civil date:       Day    After Nightfall

 

English Name of the Deceased: 

Full Hebrew Name:       Relationship: 

Hebrew Date of Passing: 

Civil date:       Day    After Nightfall

 

SERVICES & PROGRAMS I FIND USEFUL

 Calendar (every year on Rosh Hashanah)                    Torah Fax

 Chavrusa Learning                                                  Torah Forum (Cable TV)

 Classes (Lunch 'n Learn, Shabbat, Tanya etc.)            Torah Phone

 Friendship Circle (serving chidren with special needs)    Women's Group

 Jewish Holiday Guides                                              chabadofcleveland.com website

 

PLEASE LIST PROGRAMS AND SERVICES YOU WOULD LIKE (NOT LISTED ABOVE):

 

 

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