| Name(s): |
|
| Phone: |
|
| Address: |
|
| E-Mail: |
|
| Age: |
Under 30
30-40
40-50
50-60
60-70
70-80
Over 80 |
| Children (if participating) Please include gender (M or F) and age for each child listed (e.g. Sarah Cohen F 10): |
|
|
| Type of Chavurah: (number in priority order> |
|
Family (including preschool and younger aged children)
Family (including school aged children)
Family (including teens and older children)
Couples
Singles
Women only
Men only
Other (fill in) |
| Chavurah activities (number in priority order>: |
|
Study/Discussion, e.g., Jewish history, values, Israel, etc.
Celebrations, eg. Jewish holidays/Shabbat
Social, e.g. cooking, outdoors, crafts
Social Action activities
Other (fill in) |
| Would you feel comfortable hosting a chavurah gathering in your home? |
|
Yes
No
|
| If you were to create your own chavurah, what would its focus be? |
|
|
| Is there any other information that may be helpful in the matching process? |
|
|
