Many families want to belong to a synagogue community. They like knowing that they have a spiritual place to call their own. It is important, especially for children, to be able to proudly say: "This is my Shul, this is my Rabbi." Your affiliation helps us support our growing community, and ensures Chabad's viability in Laguna Beach.

Family Information

Home Address                     


Postal Code                        

Home Phone                       



Parent's Information

Husband                                                        Wife 

Name                                  Name                             

Last Name                           Last Name                      

Hebrew Name                      Hebrew Name                

Father's Hebrew Name          Father's Hebrew Name   

Mother's Hebrew Name         Mother's Hebrew Name   

Cell Phone                            Cell Phone                     

Work Phone                         Work Phone                   

Occupation                           Occupation                    

Marital status               



  Children Information

Child #1                                                       Child #2

Name                                 Name                              

Hebrew Name                     Hebrew Name                 

Date of Birth                       Date of Birth                   


Child #3                                                       Child #4

Name                                 Name                             

Hebrew Name                       Hebrew Name                 

Date of Birth                       Date of Birth                   



  Yartzeit Information (if Applicable)

Husband's Family                                          Husband's Family

Hebrew Name                     Hebrew Name                

English Name                      English Name                

Date of Passing                    Date of Passing             


Wife's Family                                                Wife's Family

Hebrew Name                     Hebrew Name                

English Name                      English Name                

Date of Passing                   Date of Passing                      



  Programs and Events

Please check the programs that interest you:

Adult Education                                        Community Service

Torah Tots Preschool                                 Community Oneg Shabbat

Ladies Home Club                                     Friday Challah Distribution

Daily Morning Service                                Holiday Programs

Tefillin Club                                              Chaplaincy

Shabbat Services                                      Mom N' Me

Lunch N' Learn                                         Hebrew School





Family $1,200                                           Bronze $1,800

Double Chai $3,600                                   Silver $5,000

Gold $7,500                                              Platinum $10,000

Diamond $18,000                                      Benefactor $26,000

A tax-deductible reciept will be issued for the full amount of your membership payments.

Affiliation entitles you to a 50% discount on High Holiday Seats


Billing Information


Card Type*
Card Number*
Expiration Date*
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Email Address*
Reconfirm Email Address*
You may acknowledge my gift to my email address
Please acknowledge my gift by mail to the above street address.
Please contact me to discuss additional giving opportunities.