Havurah Questionnaire

    Participant Information

    Adult 1 Information
    First Name
    Last Name
    Email
    Phone

    Age


    If you prefer, you may tell us your exact age:


    Occupation: (If retired, your occupation pre-retirement)


    Interests/Hobbies:

    ADD ANOTHER ADULT
    Yes
    Adult 2 Information
    First Name
    Last Name
    Email
    Phone

    Age


    If you prefer, you may tell us your exact age:


    Occupation: (If retired, your occupation pre-retirement)


    Interests/Hobbies:


    Additional Information

    If you have children, what are their ages?

    Your Preference for a Havurah (Please check all that apply)
    FamiliesCouplesSinglesSeniorYoung AdultYoung FamiliesInterest Groups (multigenerational)Other (please specify)

    I/We are interested in a Havurah that shares activities such as: (Please check all that apply)
    Co-ed Book GroupCooking ClassOutdoor ActivitiesFinance/InvestmentHistory/Current EventsCelebrate Jewish HolidaysMuseum/Art HistoryMovie/TheatreMusic/Music HistoryTravel

    Are there any other Temple Emanuel members with whom you would like to be matched?

    What additional information can you tell us to better help us match you in a Havurah?

    Would you be willing to host the initial Havurah meeting?

    YesNo