rabbi eric morgenstern - kehillah chen...

5850 Canoga Avenue, Suite 110, Woodland Hills, CA 91367 Ph: 818-245-KCVC (5282) Fx: 818-587-2969

Email: [email protected]

It is a pleasure to welcome you to Kehillah Chen v’Chesed. We are a welcoming spiritual community which strives to Embrace, Engage and Educate children, youth and adults to participate actively in worship, Torah study, Jewish life experience, and to put Universal Judaism and ethical principles into action. We seek to enrich the lives of our chevra kadisha (holy community), contribute to the continuance and vitality of the Jewish people, and commit to Tikkun Olam ― repairing the world. We welcome and encourage participation in our many spiritual, social and enrichment programs offered throughout the year. Shabbat services are once a month at the Encino Presbyterian Church and the Oneg Shabbat following services is typically hosted by a family. We look forward to having you participate with the Kehillah Chen v’Chesed family. I am available to discuss any questions you may have regarding our programs or to provide specific information to you and your family. Please complete the attached Registration Packet and return it with your contribution by August 31, 2015. If you have any questions or need further assistance, I can be reached at (818) 245-(KCVC) 5282 or by email at [email protected]. I look forward to hearing from you. Very truly yours,

Rabbi Eric Morgenstern Rabbi Eric Morgenstern

Member of the International Federation of Rabbis Enclosure


www.kcvc.org

Tell Us About Your Family…

Adult (A) Name ________________________________________________________________ First Middle Last Preferred Name ___________________Hebrew Name _________________________ Birth Date ____/____/___ Wedding Anniversary Date ____/____/___ Employer ___________________________________________________________ Work Phone _____________________ Cell Phone ____________________________ Email __________________________ Facebook _____________________________ Emergency Contact Name ______________________________________Phone ____________________

Adult (B) Name ________________________________________________________________ First Middle Last Preferred Name ___________________Hebrew Name _________________________ Birth Date ____/____/___ Wedding Anniversary Date ____/____/___ Employer ___________________________________________________________ Work Phone _____________________ Cell Phone ____________________________ Email __________________________ Facebook _____________________________


www.kcvc.org

Emergency Contact Name ______________________________________Phone ____________________ Home Address Street ________________________________________________________________ City ______________________________________ Zip ________________________ Home Phone _______________________ Home Fax ______________________ Children (1) Name ______________________________________________________________ First Middle Last Preferred Name ___________________ _____ Gender ____________________ Hebrew Name _____________________________________________________ Birth Date ____________ Current Grade ________ School ________________________________________________________________ Expected Bar/Bat Mitzvah in year _____________________________________ Home Address (if different from A and B) Street ________________________________________________________________ City _________________________________ Zip _______________________ Emergency Contact Name ______________________________________Phone ____________________

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www.kcvc.org

(2) Name ______________________________________________________________ First Middle Last Preferred Name ___________________ _____ Gender ____________________ Hebrew Name _____________________________________________________ Birth Date ____________ Current Grade ________ School ________________________________________________________________ Expected Bar/Bat Mitzvah in year _____________________________________ Home Address (if different from A and B) Street ________________________________________________________________ City _________________________________ Zip _______________________ Emergency Contact Name ______________________________________Phone ____________________

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(3) Name ______________________________________________________________ First Middle Last Preferred Name ___________________ _____ Gender ____________________ Hebrew Name _____________________________________________________ Birth Date ____________ Current Grade ________ School ________________________________________________________________ Expected Bar/Bat Mitzvah in year _____________________________________


www.kcvc.org

Home Address (if different from A and B) Street ________________________________________________________________ City _________________________________ Zip _______________________ Emergency Contact Name ______________________________________Phone ____________________

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(4) Name ______________________________________________________________ First Middle Last Preferred Name ___________________ _____ Gender ____________________ Hebrew Name _____________________________________________________ Birth Date ____________ Current Grade ________ School ________________________________________________________________ Expected Bar/Bat Mitzvah in year _____________________________________ Home Address (if different from A and B) Street ________________________________________________________________ City _________________________________ Zip _______________________ Emergency Contact Name ______________________________________Phone ____________________


www.kcvc.org

Other Information

Adult (A) Religious Background: � Reform � Conservative � Orthodox � Jew By Choice � Other ____________________________________ Bar/Bat Mitzvah: � Yes � No Confirmed � Yes � No Read Hebrew � Yes � No Speak Hebrew � Yes � No Chant Torah � Yes � No

Adult (B) Religious Background: � Reform � Conservative � Orthodox � Jew By Choice � Other ____________________________________ Bar/Bat Mitzvah: � Yes � No Confirmed � Yes � No Read Hebrew � Yes � No Speak Hebrew � Yes � No Chant Torah � Yes � No

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www.kcvc.org

Kehillah Chen v’Chesed embraces the tradition of remembering and honoring those who influenced and enriched our lives, but who have passed from this life. Please provide the information requested below so that we may include your loved one(s) on our Yahrzeit List and you will be sent a reminder 2 weeks before the date (use a separate sheet if necessary) Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______


www.kcvc.org

Kehillah Chen v’Chesed maintains its relationship data for official synagogue use only. Supporters may choose to be included in the social directory which is distributed to supporters only. I grant Kehillah Chen v’Chesed, its representatives and employees the right to take photographs and videos of me (and my family and guests), and authorize KEHILLAH CHEN V’CHESED, its assigns and transferees to copyright, use the photographs and videos in its promotional and marketing material and publicity efforts. I hereby hold harmless and release KEHILLAH CHEN V’CHESED, its representatives and employees from liability for any violation of any personal or proprietary right it may have in connection with such use. I agree that KEHILLAH CHEN V’CHESED may use such photographs and videos of me with or without my name and for any lawful purpose, including print and/or electronic usage. ______________________________ ________________________________ 1st Adult Member Signature 2nd Adult Member Signature Date _________________________ Date ___________________________

***************************************************************** Finding Your Place at Kehillah Chen v’Chesed In the great tradition of our faith, our community serves its members completely and tirelessly. We are a caring community, responding to the needs of every individual and family. Using the finest educational resources, our schools and youth programs present to our children the rich heritage of our faith. With the aid of our supporters, our full and active programs serve every age group in the community in a meaningful and personal way. Please check the boxes of the committee(s) that you would like to be contacted by and/or serve on. � KCVC Family Circle – Sponsors programs geared toward families including social events, community service activities, holiday celebrations/services and events. � Fundraising Committee -- Fund-Raising seeks "fun" ways to supplement the financial needs of our community. �Holocaust Committee -- Become involved in helping to provide holocaust enrichment programs to our community and development of a Yom Hashoah Program. �Long Range Planning Committee -- The Long Range Planning Committee shapes the future of Kehillah Chen v’Chesed with representation of all committees.



Contribution Schedule

Name: ______________________________________________________ Address: ______________________________________________________ ______________________________________________________ Phone: ______________________________________________________ ================================================================== � Annual Contribution $500.00

(Your contribution supports monthly Shabbat and High Holy Day services; Music; Use of the First Presbyterian Church of Encino; Liability Insurance and Board of Directors Insurance)

� Enrichment Program (Grades K-7) $720.00 (Location is Hesby Oaks Leadership Charter School) � Post B’nai Mitzvah Enrichment (Grade 8-12) $550.00 (Location is Hesby Oaks Leadership Charter School. Days and Times of session to be determined) � B’nai Mitzvah Service $1800.00

(This includes the services of the Rabbi, ONE of our Cantorial Soloists)

� Private Hebrew Tutoring $65.00/hour (Tutor, schedule and location to be determined by Rabbi)

� Oneg Shabbat $36.00

(Pledge your contribution to commemorate a life cycle event such as a birthday, wedding anniversary, Bar/Bat Mitzvah, etc.)



� Additional Contribution (If any): (Additional Contributions help support: Families In Need, Kid’s Club Events, Memorial Giving, Rabbi’s Discretionary Fund) (Please Select an Amount) � $1800.00 � $1000.00 � $500.00 � $180.00 $_____________ Total Contribution: $_____________ The best way to submit your contribution is through KCVC's PayPal online system and then forward this form to us for accurate processing. It's safe and easy. Contributions may be sent to KCVC by postal mail. All contributions submitted by postal mail, including third party payments, must be sent to KCVC with a copy of this Contribution Schedule. Checks and money orders must be made payable to Kehillah Chen v’Chesed (NO Acronym’s Please) in U.S. funds only and sent to the address below.

Kehillah Chen v’Chesed 5850 Canoga Avenue

Suite 110 Woodland Hills, CA 91367



Enrichment Enrollment

Tuesday Afternoon 4:00 PM (Grades K-2) Child 1______________________________________________________ Child 2______________________________________________________ Child 3______________________________________________________ Child 4______________________________________________________

Tuesday Afternoon 4:00 PM (Grades 3-5) Child 1______________________________________________________ Child 2______________________________________________________ Child 3______________________________________________________ Child 4______________________________________________________



Tuesday Afternoon 6:30 PM (Grades 6-7) Child 1______________________________________________________ Child 2______________________________________________________ Child 3______________________________________________________ Child 4______________________________________________________

Post B’nai Mitzvah (Location, Days and Times to be determined based upon enrollment)

Child 1______________________________________________________ Child 2______________________________________________________ Child 3______________________________________________________ Child 4______________________________________________________

Kehillah Chen v’Chesed חסד‘קהילת חן ו

A Jewish Universalist Synagogue


www.kcvc.org

Required Book List Grades 3 & up

Derech Binah: The Hebrew Primer Price: $13.95 In stock Available at: Behrman House Online www.behrmanhouse.com

Mishkan T'filah: A Reform Siddur, Transliterated Price: $38.00 In Stock Available at: CCAR Press Online www.ccarnet.org

JPS Hebrew-English TANAKH, Student Edition Price: $30.56 In Stock Available at: Amazon Online www.amazon.com

** For those preparing for their B’nai Mitzvah, you will need to purchase the Parasha book relating to your B’nai Mitzvah Date. Rabbi will advise as to which portion you need. Here is the website for the books: Parasha HaShavuah Available at: URJ Books and Music Price: $13.95 In Stock http://urjbooksandmusic.com

Derech Binah: Reading Workbook Price: $5.95 In stock Available at: Behrman House Online www.behrmanhouse.com



High Holy Day Services Reservation Form Name: ______________________________________________________ Address: ______________________________________________________ ______________________________________________________ Phone: ______________________________________________________ ================================================================== Please tell us which services you will be attending and how many seats you will need. � Erev Rosh Hashanah (September 13th at 7:45 pm) ________ � Rosh Hashanah (September 14th at 10:30 am) ________ � Kol Nidre (September 22nd at 7:45 pm) ________ � Yom Kippur (September 23rd at 10:30 am) ________ � Ne’ila / Havdalah (September 23rd at 5:30 pm) ________



Release Kehillah Chen v’Chesed maintains its relationship data for official synagogue use only. Supporters may choose to be included in the social directory which is distributed to supporters only. I grant Kehillah Chen v’Chesed, its representatives and employees the right to take photographs and videos of me (and my family and guests), and authorize Kehillah Chen v’Chesed, its assigns and transferees to copyright, use the photographs and videos in its promotional and marketing material and publicity efforts. I hereby hold harmless and release Kehillah Chen v’Chesed, its representatives and employees from liability for any violation of any personal or proprietary right it may have in connection with such use. I agree that Kehillah Chen v’Chesed may use such photographs and videos of me with or without my name and for any lawful purpose, including print and/or electronic usage. _____________________________________ Cohort Signature _____________________________________ Cohort Signature Date ________________________________



Medical Treatment Authorization Form This form grants temporary authority to a designated adult to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal Guardians, and it may not be feasible or practical to contact them. This form should be given to the trip leader or shown to the trip leader and then carried by the designated adult. Minor Full Legal Name: ___________________________________________________________________ Home Address: ____________________________________________________________________ ____________________________________________________________________ Date of Birth: ______________________ Gender: F____ M____ Information for Medical Treatment Physician’s Name and Location of Practice: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Physician’s Phone # (if known): (____) ________________ Medical Insurer/Health Plan: ________________ Policy #: ___________________ Allergies to Medications: ________________________________________________ Allergies (Other): ________________________________________________________



Please note all conditions for which the child is currently receiving treatment and any other significant medical information: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S) I do hereby state that I have legal custody of the aforementioned Minor. I grant my authorization and consent for _________________________________________ (hereafter “Designated Adult”) to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and treat the minor and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. This authorization is effective through: ______________________________________. Signed this _______________day of________________________, 20_____________. Parent / Legal Guardian Signature: _________________________________________ Printed Name: __________________________________________________________ Witness Signature: ______________________________________________________ Printed Name: __________________________________________________________



“KEHILLAH KIDS” EMERGENCY RELEASE FORM Student’s Name___________________ Date of Birth ________________ Student’s Name___________________ Date of Birth ________________ Student’s Name___________________ Date of Birth ________________ Student’s Name___________________ Date of Birth ________________ I, the undersigned parent/guardian of the above child(ren) do hereby state that I have legal custody of the aforementioned Minor(s) and authorize Kehillah Chen v’Chesed and its authorized representatives as agents for the undersigned, to consent to any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to Provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached. The authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California.



I give my permission for my child(ren) _____________________________ to participate in all KCVC programs, activities and events and do release Kehillah Chen v’Chesed and its representatives from all liability arising out of my child’s participation. Parent / Legal Guardian Signature: _______________________________ Date: __________________ Printed Name: ________________________________________________ Witness Signature: ____________________________________________ Date: __________________ Printed Name: ________________________________________________



“KEHILLAH KIDS” CODE OF CONDUCT I will promote the creation of a youth community based on mutual respect and a sense of personal well-being. I will treat others with honor and respect. I have read the following rules, designed to promote the health and safety of all event participants, and have indicated my complete acceptance with my signature and that of my parent/guardian. • I will not possess, consume, or distribute alcoholic beverages while attending Kehillah Kids Group events. • I will not possess, use, or distribute any illegal drug or drug paraphernalia. • I will not smoke or consume or distribute tobacco products at any time. • I will not bring or use any weapons, firearms, or anything that may be construed as a weapon. • I will not commit any illegal act. I understand that vandalism, disturbing the peace or other inappropriate behavior as determined by the chaperones will not be tolerated. I understand that I will have to pay for any damages that I cause. I understand that no gambling is allowed. • I will not participate in any activities that could be deemed as hazing, sexually harassing, demeaning, or hurtful. • I agree to abide by any additional rules, pertinent to the specific event, which may be announced, and to accept the consequences of their violation. • I will attend and participate fully in the entire event, unless otherwise agreed upon with my chaperone or guardian. I will arrive on time, stay to the end, and remain on the event premises at all times. • I understand that these rules of behavior apply from the time I leave home for the event, during the event itself, and until I return home after the event. We understand that part of the Kehillah Kids experience involves activities and interactions that may be new for my child. These things come with certain risks and uncertainties beyond what my child may be used to dealing with at home. I am aware of these risks, and I am assuming them on behalf of my child.



I realize that no environment is risk free and so I have to instruct my child on the importance of abiding by the Code of Conduct. My child(ren) and I both agree that he or she is/are familiar with these rules and will obey them. We further understand that sanctions imposed by any chaperone for any violation could include immediate expulsion from the event, at the expense of the parent or guardian. Student’s Name: ______________________________________________ Student signature: _____________________________________________ Student’s Name: ______________________________________________ Student signature: _____________________________________________ Student’s Name: ______________________________________________ Student signature: _____________________________________________ Parent’s Name: _______________________________________________ Parent’s signature: ____________________________________________ Home Phone: ______________ Cell Phone: _________________



Emergency / Disaster Release Form Student: First Name __________________Last Name________________________ Home Address _______________________________________________ ____________________________________________________________ Home Phone_______________ Mother’s Name: ______________________________________________ Work Phone_______________ Cell Phone_______________ Father’s Name: ______________________________________________ Work Phone_______________ Cell Phone_______________ Guardian (if different than above) Name: ______________________________________________________ Work Phone_______________ Cell Phone_______________ Release Statements: Circle One: I authorize release of my son/daughter to any adult with Whom he/she feels comfortable. Yes No I wish for my son/daughter to remain at school until picked up by parent. Yes No



If I/we are unable to pick up our child, I/we designate the following People to whom my son/daughter may be released in case of emergency: Name: ______________________________________________________ Work Phone_______________ Cell Phone_______________ Name: ______________________________________________________ Work Phone_______________ Cell Phone_______________ Please list a friend or family member, who lives out of state that we can call with information in case local Telephone service is interrupted. Name: ______________________________________________________ Relationship:_________________________________________________ Work Phone_______________ Cell Phone_______________ Medical Alert: Condition: ________________________________________ ____________________________________________________________ Medication___________________________________________________ Form Completed by: Name (Print) _________________________________________________ Signature____________________________________________________ Relationship to Student: _______________ Date: __________________

rabbi eric morgenstern - kehillah chen...

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