I am grateful that you have decided to join and support our community.

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1 Dear Chevra Kadisha, I am grateful that you have decided to join and support our community. We welcome and encourage participation in our many spiritual, social and enrichment programs offered throughout the year including High Holy Days, Special Holiday Programs and Mitzvah Days. Also, please don t forget to join us for Shabbat services which are held at 7:00PM on the Third Friday of each month at the First Presbyterian Church of Encino. Shabbat Services could not be complete without an Oneg Shabbat that is typically hosted by some of our families. There are several forms attached that will assist us in providing your family with comprehensive Spiritual Assistances. Please complete the essential forms and return them to us as soon as possible. If you have any questions or need further assistance, I can be reached at (818) 245- (KCVC) 5282 or by at I look forward to hearing from you. Very truly yours, Rabbi Eric Morgenstern Rabbi Eric Morgenstern Member of the International Federation of Rabbis

2 Tell Us About Your Family Family Name: Adult One: Adult Two: Hebrew Name: Hebrew Name: Birth Date: Birth Date: Child One: Child Two: Hebrew Name: Hebrew Name: Birth Date: Birth Date: Child Three: Child Four: Hebrew Name: Hebrew Name: Birth Date: Birth Date: Primary Phone: Cell Phone: Primary Facebook: Home Address Street City Zip

3 Emergency Contact Name Phone 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 Signature 2nd Adult Signature Date: Date:

4 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)

5 Family Pledge Family Name: Suggest Annual Pledge of Support $ (Your pledge 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 $ Confirmation Program $ Enrichment Classroom Fee $75.00 (Mandatory fee for each child who attends one of our Enrichment Programs) B nai Mitzvah Ceremony: (This includes the services of the Rabbi, ONE of our Cantorial Soloists; Six months of Private Tutoring and Booklet Design) Community Supporter $ Non-Community Supporter $ B nai Mitzvah Set Up Fee (Depending on venue) $ Oneg Shabbat $36.00 (Your pledge supports monthly Oneg Shabbat) Prayer Book Pledge ($42 per book): (Your pledge allows for the purchase of Shabbat, Weekdays and Festival Prayer Books to be kept at the Synagogue, identified with a book plate) $ Grand Total Pledge of Support: $

6 Dear KCVC Family, If you agree to Pledge to support KCVC and KCVC Programs by becoming a cohort this year or enrolling your child in one of our Enrichment Programs, please return the completed Pledge Form and choose from the options below that best meet your needs. We ask that Pledge Payments are made by the 15th of the month. Also, you can establish automatic bank payment plans with your bank so that your payment is automatically sent to KCVC. Please select one box for billing: NAME Pay in full within 30 days Semi-annual (the total amount due divided into 2 equal payments; August & January Quarterly (the total amount due divided into 4 equal payments; August, November, February & May) Monthly (the total amount due divided into 10 equal payments from August through May I look forward to hearing from you. Very truly yours, Rabbi Eric Morgenstern Rabbi Eric Morgenstern Member of the International Federation of Rabbis

7 Dear Friends and Family, This year we begin our fifth year as a community! What an amazing group we have become and it is all due to your continued involvement and support and for that, I am truly grateful. We have always maintained a policy of keeping out expenses at a minimum and providing the services at a maximum and we would love to continue that tradition. However, as we all know, everything in life costs money and a Synagogue is no different. Your annual pledge covers 99% of our expenses. However, what it does not cover are those unusual expenses that creep up from time to time. The last unusual expense was the purchase of our Torah. What a wonderful and welcomed addition it was to our community Now, we have another such unusual expense. We would like to aquire a second Torah for our community. As you may recall, our original Torah is over 150 years old and has survived the Holocaust. Although it has been a tremendous gift for us all to use and read from, we would really benfit from the purchase of a second Torah. I am in need of $12,000 to complete this project. I am asking each of you to please demonstrate how much you value Kehillah Chen v Chesed by contributing as much as you can towards this Appeal. Your pledge to this Appeal will be matched by my pledge to build upon your trust and ensure KCVC continues to serve our Jewish spiritual, social, and educational needs, as well as those of the greater community. As we look forward to 5778 and to marking our community s significant role in the village and in the lives of our supporters, I extend my best wishes to you and your family for a happy, healthy and peaceful New Year! Tikateivu, - L'Shana Tova הנשל הבוט ובתכת Rabbi Eric Morgenstern

8 You can make your pledge to KCVC s Appeal by: 1. Tearing off the Appeal section of this form and returning it to the Synagogue Office. 2. Logging onto the KCVC website ( and use PayPal. 3. Calling the Sue in the Synagogue office ( ) 9:00 AM - 5:00 PM (3:00 PM on Fridays). Name: Address: Phone: Additional Pledge (If any): $

9 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 9th at 7:00 pm) Rosh Hashanah (September 10st at 10:00 am) Kol Nidre (September 18th at 7:00 pm) Yom Kippur (September 19th at 10:00 am) Yom Kippur Study Session (September 19th at 4:00 PM) Yizkor / Ne ila / Havdalah (September 19th at 5:30 pm) ***Please Note: Although High Holiday Service Attendance is "free of charge we would truly appreciate any financial support you could offer. Please leave what you can in the Tzadakah Box or in the envelopes provided. L shanah Tova!!

10 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

11 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:

12 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):

13 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:

14 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. Community Supporter Signature Community Supporter Signature Date

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