Shir Ami, Bucks County Jewish Congregation

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Shafty Membership
Stain glass windows in the Shir Ami Sanctuary.
Stain Glass windows in the Shir Ami Sanctuary

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Shir Ami

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SHAFTY Membership Application

APPLICANT INFORMATION Include child email separately from parent(s)

Use the form to submit your application; make check payable to Shir Ami Federation of Temple Youth
After submitting your application please fill out the
Medical Disclaimer

 

 

 

 

 

 

 

1st Child/Teen Full Name

 

2nd Child/Teen Full Name

 

Child/Teen Email

 

Child/Teen Email

 

Grade as of 9/2007

 

Grade as of 9/2007

 

DOB

 

DOB

 

Babysitter Club*

   yes  no

 

 

 

 

SR     JR

Bonim     Chal.

 

SR     JR

Bonim     Chal.

 

3rd Child/Teen Full Name

 

4thChild/Teen Full Name

 

Child/Teen Email

 

Child/Teen Email

 

Grade as of 9/2007

 

Grade as of 9/2007

 

DOB

 

DOB

 

SR     JR

Bonim     Chal.

 

SR     JR

Bonim     Chal.

 

PARENT INFORMATION

 

 

 

 

 

First Names

 

Last Name

 

Mailing Address

 

City

 

Home Phone

 

State

 

Mom Cell #

 

ZIP

 

Dad Cell #

 

 

 

 

Mom Email

 

Comments

 

Dad Email

 

 

 

Parent Youth Committee**

yes    no

 

 Code of Conduct

Medical Disclaimer

*Babysitters Club
Is open to all SHAFTY members in 8th-12th Grades. Your name, grade, and telephone number will be posted on the SHAFTY Bulletin Board. Your email address will be posted on the SHAFTY website, WWW.SHAFTY.NET
**Parent Youth Committee
Is a special group of volunteer parents who are committed to supporting, promoting, and facilitating youth activities. The Committee is seeking new volunteers. We meet approximately four times yearly. For information contact Abby Simkus, rsimkus@comcast.net

MEMBERSHIP FEES

GROUP

GRADES

SHIR AMI MEMBER

  NON SHIR AMI MEMBER

SR. SHAFTY

9-12

$50*

$55**

JR. SHAFTY

 7 & 8

$25

$30

BONIM

5 & 6

$20

$25

CHALUTZIM

3 & 4

$20

$25

* $18 applied toward nfty/par dues
**Non-congregants may join shafty
Affix one membership check made payable to shafty

Shir Ami Federation of Temple Youth 101 Richboro Rd  Newtown, PA 18940
Sr. Hotline: (215) 968-3400 x310   Jr/Bonim/Chal. Hotline: (215) 968-3400 x311
SHAFTY Email: fernelevy@hotmail.com or shaftyrsvp@comcast.net


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Shir Ami
101 Richboro Road
Newtown, PA 18940
215 968 3400
email Shir Ami

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