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Kesher: An Intergenerational Friendship Initiative
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* Indicates required question
Please select your age:
*
Over 65
Under 65
Please name (first and last) all participants within your household:
*
Your answer
If applicable, please indicate ages of children within your household:
*
Your answer
Which languages do you speak?
*
English
Spanish
Russian
Other:
Required
Home address:
*
Your answer
Primary phone number:
*
If you have more than one phone numbers available, you may provide another as an "alternate number" in the next question.
Your answer
Alternate phone number:
Your answer
Primary email address:
*
If you have more than one email address available, you may provide another as an "alternate email address" in the next question.
Your answer
Alternate email address:
Your answer
Please check all methods of contact with which you would feel comfortable.
*
Traditional (snail) mail
Email
Phone
Videochat/facetime
In person meeting (for the post-pandemic future)
Other:
Required
Please describe some of your interests:
If filling out on behalf of more than one individual, you may provide everyone's interests here.
Your answer
Do you currently participate in any Y programs?
Y Parenting Center
Ukulele Shabbat
Nursery School
Be Me After School
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