Family Information & Branch Survey

Step 1 of 3

33%

General Information

Parent/guardian name(Required)

First Last

Parent/guardian cellphone number(Required)

Household phone number

Family home address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Family Information

Which parent passed away?(Required)

Father's name(Required)

Yahrtzeit month(Required)

Yahrtzeit day(Required)

Yahrtzeit year (Hebrew)(Required)

Mother's name(Required)

Yahrtzeit month(Required)

Yahrtzeit day(Required)

Yahrtzeit year (Hebrew)(Required)

Child #1 information

Child 1 name(Required)

First Last

Child 1 DOB(Required)

MM slash DD slash YYYY

Child 1 grade(Required)

Child 1 school(Required)

Does child 1 have a personal cell number?(Required)

Yes

Child 1 cell number(Required)

Does child 1 have a personal email?(Required)

Yes

Child 1 email(Required)

Do you have additional single children?

Yes

Child #2 information

Child 2 name(Required)

First Last

Child 2 DOB(Required)

MM slash DD slash YYYY

Child 2 grade(Required)

Child 2 school(Required)

Does child 2 have a personal cell number?(Required)

Yes

Child 2 cell number(Required)

Does child 2 have a personal email?(Required)

Yes

Child 2 email(Required)

Do you have additional single children?

Yes

Child #3 information

Child 3 name(Required)

First Last

Child 3 DOB(Required)

MM slash DD slash YYYY

Child 3 grade(Required)

Child 3 school(Required)

Does child 3 have a personal cell number?(Required)

Yes

Child 3 cell number(Required)

Does child 3 have a personal email?(Required)

Yes

Child 3 email(Required)

Do you have additional single children?

Yes

Child #4 information

Child 4 name

First Last

Child 4 DOB(Required)

MM slash DD slash YYYY

Child 4 grade(Required)

Child 4 school(Required)

Does child 4 have a personal cell number?(Required)

Yes

Child 4 cell number(Required)

Does child 4 have a personal email?(Required)

Yes

Child 4 email(Required)

Do you have additional single children?

Yes

Child #5 information

Child 5 name

First Last

Child 5 DOB(Required)

MM slash DD slash YYYY

Child 5 grade(Required)

Child 5 school(Required)

Does child 5 have a personal cell number?(Required)

Yes

Child 5 cell number(Required)

Does child 5 have a personal email?(Required)

Yes

Child 5 email(Required)

Do you have additional single children?(Required)

Yes

Child #6 information

Child 6 name

First Last

Child 6 DOB(Required)

MM slash DD slash YYYY

Child 6 grade(Required)

Child 6 school(Required)

Does child 6 have a personal cell number?(Required)

Yes

Child 6 cell number(Required)

Does child 6 have a personal email?(Required)

Yes

Child 6 email(Required)

Do you have additional single children?(Required)

Yes

Child #7 information

Child 7 name

First Last

Child 7 DOB(Required)

MM slash DD slash YYYY

Child 7 grade(Required)

Child 7 school(Required)

Does child 7 have a personal cell number?(Required)

Yes

Child 7 cell number(Required)

Does child 7 have a personal email?(Required)

Yes

Child 7 email(Required)

Do you have additional single children?(Required)

Yes

Child #8 information

Child 8 name

First Last

Child 8 DOB(Required)

MM slash DD slash YYYY

Child 8 grade(Required)

Child 8 school(Required)

Does child 8 have a personal cell number?(Required)

Yes

Child 8 cell number(Required)

Does child 8 have a personal email?(Required)

Yes

Child 8 email(Required)

Do you have additional single children?(Required)

Yes

Child #9 information

Child 9 name

First Last

Child 9 DOB(Required)

MM slash DD slash YYYY

Child 9 grade(Required)

Child 9 school(Required)

Does child 9 have a personal cell number?(Required)

Yes

Child 9 cell number(Required)

Does child 9 have a personal email?(Required)

Yes

Child 9 email(Required)

Do you have additional single children?(Required)

Yes

Child #10 information

Child 10 name

First Last

Child 10 DOB(Required)

MM slash DD slash YYYY

Child 10 grade(Required)

Child 10 school(Required)

Does child 10 have a personal cell number?(Required)

Yes

Child 10 cell number(Required)

Does child 10 have a personal email?(Required)

Yes

Child 10 email(Required)

Do you have married children who were part of Zisels's Links/Shlomie's Club?(Required)

Yes

Married child #1 information

Married Child 1 full married name(Required)

First Last

Married Child 1 cellphone number(Required)

Married Child 1 email(Required)

Do you have additional married children?(Required)

Yes

Married child #2 information

Married Child 2 full married name(Required)

First Last

Married Child 2 cellphone number(Required)

Married Child 2 email(Required)

Do you have additional married children?(Required)

Yes

Married child #3 information

Married Child 3 full married name(Required)

First Last

Married Child 3 cellphone number(Required)

Married Child 3 email(Required)

Do you have additional married children?(Required)

Yes

Married child #4 information

Married Child 4 full married name(Required)

First Last

Married Child 4 cellphone number(Required)

Married Child 4 email(Required)

Do you have additional married children?(Required)

Yes

Married child #5 information

Married Child 5 full married name(Required)

First Last

Married Child 5 cellphone number(Required)

Married Child 5 email(Required)

Do you have additional married children?(Required)

Yes

Married child #6 information

Married Child 6 full married name(Required)

First Last

Married Child 6 cellphone number(Required)

Married Child 6 email(Required)

Branch Survey

We're looking for your input on our current branches, as well as locations that would be well served by a local branch. (A local branch means local events for boys and girls ages 6-23, seasonal gifts, and local branch leaders.) Our current branch locations are: NY/NJ - Serving all of NY and NJ; Baltimore - serving the Baltimore/Silver Spring communities; Chicago - serving the Chicago and Milwaukee communities; Cleveland - serving Cleveland, Cincinnati, Columbus, Detroit, Pittsburg; Los Angeles - serving LA and surrounding cities; and our newest branch location, Florida - serving all South Florida neighborhoods

Are you currently part of a branch location?(Required)

Yes

Which branch are you a part of?(Required)

In the last 12 months, has your child(ren) attended events locally?(Required)

Yes

Which events did your child(ren) like most and want to see more of?(Required)

Let's learn: why has your child(ren) not attended events in the last 12 months?(Required)

Is there anything you'd like to share about what's working well for your branch?(Required)

Is there anything you wish were different about your branch?(Required)

Tell us what you appreciate about any specific branch leader(Required)

Is there anything you wish were different about your branch leaders?(Required)

What sort of events and programming would you like to see added?(Required)

Do you prefer events to be held on Motzoei Shabbos, Sunday, or a weeknight?(Required)

Motzoei Shabbos

Sunday

Weeknight

No preference

How comfortable are you when you meet your branch leaders outside of events?(Required)

Very comfortable

Somewhat comfortable

Neutral

Somewhat uncomfortable

Very uncomfortable

How comfortable are you approaching your local branch leaders for help with anything personal for your family?(Required)

Very comfortable

Somewhat comfortable

Neutral

Somewhat uncomfortable

Very uncomfortable

Which neighborhood/city do you live in?(Required)

Which state?(Required)

Do you know any families within a 1-hour drive who have also lost a parent?(Required)

Yes

Can you share their names?(Required)

Thank you for helping us update our records and gain beneficial insights to our branches.

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5786 Family Information and Branch Survey

General Information

Family Information

Child #1 information

Child #2 information

Child #3 information

Child #4 information

Child #5 information

Child #6 information

Child #7 information

Child #8 information

Child #9 information

Child #10 information

Married child #1 information

Married child #2 information

Married child #3 information

Married child #4 information

Married child #5 information

Married child #6 information

Branch Survey

Thank you for helping us update our records and gain beneficial insights to our branches.

A joy shared is a joy multiplied. A sorrow shared is a sorrow divided.