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Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
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June 1, 2022 to May 31, 2023
11301 W. Broward Boulevard, Plantation, FL 33325
954-472-3600/ Fax 954-472-3622
ramatshalom@ramatshalom.org
Household Information
Family Name:
*
Home Phone:
*
Address:
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Adult 1 Name:
*
Adult 1 Cell Phone:
*
Adult 1 Email:
*
Adult 2 Name:
Adult 2 Cell Phone:
Adult 2 Email:
Does Ramat Shalom have permission to share your contact information with the congregation?
*
Yes
No
Name, Grade, School, and Email for ALL CHILDREN (including college and university) as of August 2022
Child 1 Name:
Child 1 Identified Gender:
Child 1 Grade:
Child 1 School:
Child 1 Email:
Child 2 Name:
Child 2 Identified Gender:
Child 2 Grade:
Child 2 School:
Child 2 Email:
Child 3 Name:
Child 3 Identified Gender:
Child 3 Grade:
Child 3 School:
Child 3 Email:
Please Refer To The Fee Schedule To Complete The Following:
Congregational Fees
Opportunities to Give!
Congregational Fees (Section A on Fee Sheet):
Torah School Assistance Fund:
Registration Fee $100 (waived before 6/15):
Gift of the Heart Scholarship Fund:
Torah School/iServe Fees (Section B on Fee Sheet):
Sam & Laura Hoffman Scholarship Fund:
Torah School Registration Fee $100 (waived before 6/15):
Burning the Mortgage Fund:
Additional Fees
Congregational Fees SUB-TOTAL :
Security: (Required per household)
$200.00
Additional Fees SUB-TOTAL:
Kochavim (Youth Choir):
$80/child
Opportunities to Give SUB-TOTAL:
TOTAL:
*Separate application for Torah School and youth programs MUST be completed for each child.
Payment Options
Pay in Full
Pay in 4 Installments, $12/payment installment fee (payments due: 6/1, 8/1, 10/1, 12/1)
Pay in 10 Installments, $12/payment installment fee (payments due monthly beginning on 6/1)
NOTE: If you are paying in installments, please contact our office. Whenever possible, we appreciate your payment by check or cash. All credit card transactions will be assessed a 3% convenience fee.
Payment Information
Check #:
Check Amount Enclosed:
Am. Express, Visa, MasterCard, Discover Account #:
Expiration Date:
Name (as it appears on credit card):
Credit Card Billing Address:
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
The congregational year for Ramat Shalom begins June 1st, 2022. I understand that membership dues are payable annually and are not transferable or refundable. In the event that I am unable to meet any of these payments or require a change in my payment arrangement, it is my obligation and responsibility to notify the Director of Administration to avoid losing my membership-in-good-standing and the attendant rights.
Electronic Signature:
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Date:
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By clicking Submit, I authorize Ramat Shalom to automatically charge the above credit card according to the method of payment specified above.
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