New Member Application 2025-26 - Form - Glen Rock Jewish Center

Welcome to Glen Rock Jewish Center! Please read our application carefully, and feel free to ask any questions you might have. Email office@grjc.org.

We will contact you after we receive your completed application.

We welcome all, regardless of your financial situation. If you believe you require assistance, please contact Galit Levinsky at office@grjc.org BEFORE completing this application.
All financial information is kept in strict confidence.

Please first select the number of adults in your household. The form will appear once you make a selection.

* How many adults are in your household?

You must make a selection in order to enter your information.

PERSONAL INFORMATION

Adult 1: Last name

Adult 2: Last name

Member 1: First name

Member 2: First name

Member 1: Date of birth

Member 2: Date of birth

Member 1: Marital status

Member 2: Marital status

Member 1: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun (you may list below)

Member 2: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun (you may list below)

Member 1: Please list any other personal pronoun here

Member 2: Please list any other personal pronoun here

Member 1: Email address

Member 2: Email address

Member 1: Occupation/Title

Member 2: Occupation/Title

* Employer Name (if not currently employed, please write "n/a")

Member 1: Work phone

Member 2: Work phone

Member 1: Cell phone

Member 2: Cell phone

Member 1: Religion

Member 2: Religion

Member 1: If converted, please name officiating rabbi, location and approximate date of conversion (if converted, this information is required)

Member 2: If converted, please name officiating rabbi, location and approximate date of conversion (if converted, this information is required)

Member 1: Hebrew name (if applicable). Please write your Hebrew name in English, and include mother's and father's Hebrew names, if known; e.g., Rachel bat Sara; David ben Isaac.

HOUSEHOLD INFORMATION

Date of marriage (if applicable)

Previous synagogue affiliation (if applicable):

How did you hear about us? What attracted you to the GRJC?

ADDRESS

Number and street

City

State

Zip Code

Home phone number (if applicable)

CHILDREN

We welcome children of all faiths, but please note that in order to become b'nei mitzvah, children need to be Jewish as defined by the Conservative movement. If you have any questions, you may contact Rabbi Schlosberg at rabbi@grjc.org.

Please note: when selecting the number of children below, you only need to include children who are younger than 18 and residing with you.

Number of children:

You must make a selection in order to enter your child(ren)'s information. Applies to each of your children who reside with you.

1st Child

2nd Child

3rd Child

4th Child

Child 1: Last name

Child 2: Last name

Child 3: Last name

Child 4: Last name

Child 1: First name

Child 2: First name

Child 3: First name

Child 4: First name

Child 1: Birth date

Child 2: Birth date

Child 3: Birth date

Child 4: Birth date

Child 1: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun

Child 1: List any other personal pronouns

Child 2: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun

Child 2: List any other personal pronouns

Child 3: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun

Child 3: List any other personal pronouns

Child 4: Preferred Personal Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsAnother Pronoun

Child 4: List any other personal pronouns

Child 1: School grade Sept. 2025

Child 2: School grade Sept. 2025

Child 3: School grade Sept. 2025

Child 4: School grade Sept. 2025

Child 1: School Name

Child 2: School Name

Child 3: School Name

Child 4: School Name

Child 1: Hebrew name (if applicable) - please write in English

Child 2: Hebrew name (if applicable) - please write in English

Child 3: Hebrew name (if applicable) - please write in English

Child 4: Hebrew name (if applicable) - please write in English

Names of any adult children who do NOT reside with you

PLEASE LET US KNOW...

How did you hear about Glen Rock Jewish Center?

What are your hopes for being part of the GRJC Community?

I WOULD LIKE TO VOLUNTEER!
We welcome our members to become involved in synagogue life and activities. Please let us know what your interests are, or if there is any specific group you would like to be a part of.

1. MEMBERSHIP

The information below is provided to you here so that you know the financial obligations of membership up front. You do not need to submit any payment at this time. After your application is reviewed, someone from the GRJC will be in touch with you to go over all details and make payment arrangements.

Our Sustainers' Circle membership was created to help those of our members who would like to give more generously. This membership level includes:
- Membership dues
- Security Fee
- Hebrew School tuition (if applicable) and any other associated Hebrew School fees (e.g. b'nei mitzvah fee)
- Kol Nidre/Yom Kippur Pledge
- Select paid programming, as noted in program registration details
- An invitation to one or two special events held throughout the year

Sustainers' Circle membership does NOT include:
- Any applicable Building Fund payments
- Yahrzeit donations or other voluntary donations made in honor or memory of someone
- Tickets to events such as the Annual Gala or other larger fundraising events.

Membership Dues amounts are as follows. Please note that while these are our standard dues, financial assistance is available and we will work with anyone who wishes to be a member of our community. All information regarding financial assistance is kept strictly confidential:

Family (two heads of household): $2,950
Family (one head of household): $1,850
Senior (two heads of household, both 65+): $2,850
Senior (one head of household, 65+): $1,750
Associate - primary residence 100 miles from GRJC (one or two heads of household): $1,000
Sustainers' Circle (with children in Hebrew School): $9,500
Sustainers' Circle (no Hebrew School): $6,500

Please let us know which membership type you are selecting:

Family - two heads of householdFamily - one head of householdSenior - two heads of household, both 65+Senior - one head of household 65+Associate - one or two heads of householdSustainers' Circle with no Hebrew SchoolSustainers' Circle with children in Hebrew School

2. SECURITY FEE

The Security Fee, which helps to cover GRJC's expenses for security guard coverage, will be added to your annual dues amount:

Hebrew School Supplemental Security Fee: $250/year
Two heads of household: $400/year
One head of household: $235/year

3. BUILDING FUND

Building Fund payments go towards capital improvements to our building and must be paid before the date of your oldest child's bar/bat mitzvah (or within three years). Your building fund payment will be added to your annual dues amount.

If you were previously a member at another synagogue where you paid a building fund, please let us know. If you are able to provide us with documentation of the amount paid, we will deduct the same amount from ours.

Two heads of household: $1,800 ($600/year)
One head of household: $900 ($300/year)

* Signature of Member 1

Please type your name here

Signature of Member 2

Please type your name here