Family Information Company*Parent 1 First Name*Parent 1 Last Name*Parent 2 First NameParent 2 Last NameStreet Address*City*State*Zip/Postal Code*Preferred Phone*--select an item--Home Work Mobile Other Preferred Phone Number*Preferred Email*Youngest Child First Name*Youngest Child Last Name*Youngest Child Date of Birth*Do you have additional children in your family? Please check if yes.Additional ChildrenChild 2 First NameChild 2 Last NameChild 2 Date of BirthChild 3 First NameChild 3 Last NameChild 3 Date of BirthChild 4 First NameChild 4 Last NameChild 4 Date of BirthChild 5 First NameChild 5 Last NameChild 5 Date of BirthChild 6 First NameChild 6 Last NameChild 6 Date of BirthChild 7 First NameChild 7 Last NameChild 7 Date of BirthPlease enter information for any additional children in Family (Ages 2-7)Are you new to Montgomery County (moved within the last year)?*YesNo--select an item--Yes No How did you first hear about Jewish Family Ambassadors (JFA)? *--select an item--Other Bender JCC programs PJ Library Friend/Family MeetUp JConnect.org Synagogue Parent Social Media group or list serve Check all Jewish programming your child(ren) has attended, if ever?*My child(ren) has never attended Jewish ProgrammingCommunity events/programs (e.g. J Play, Chabad, PJ Library)Synagogue programmingJewish PreschoolHoliday programmingOtherMy child(ren) has never attended Jewish Programming Community events/programs (e.g. J Play, Chabad, PJ Library) Synagogue programming Jewish Preschool Holiday programming Other Do you have a PJ Library subscription to receive a FREE picture book monthly for your Jewish Family Library?*YesNot yet!--select an item--Yes Not yet! How does your family identify?*--select an item--Jewish Interfaith Other On a scale of 1 to 5, with 1 being the "least connected" and 5 being the "most connected," how connected do you feel to your local Jewish community?*12345--select an item--1 2 3 4 5 When is the best time of the week for your family to attend programming?*--select an item--Weekdays Weeknights Weekends Other No preference What types of programming would you like to attend with your family?*Parent's Night Out eventsFamily Dinners/Shabbat Circles/Holiday DinnersPlaygroupsJewish themed programsParenting seminars/educational eventsKids classes (ex: gym, storytime, music)Family friendly holiday programs and concertsIsraeli programmingFamily friendly holiday concertsParent's Night Out events Family Dinners/Shabbat Circles/Holiday Dinners Playgroups Jewish themed programs Parenting seminars/educational events Kids classes (ex: gym, storytime, music) Family friendly holiday programs and concerts Israeli programming Family friendly holiday concerts In the past 3 years, have you or anyone in your household participated in any events/programs/classes at or presented by the Bender JCC?*--select an item--Yes No We would love to get to know you! We're happy to meet you at a coffee shop, over the phone or just to get to know you at your first Jewish Family Ambassador Playdate! Please select your preference. I would like to meet:Meeting preference--select an item--In Person Virtually No meeting necessary, email me upcoming events Record TypeSurvey CompletedDate of Completed Survey
