Life Cycle and Healing Form

The GHC community is just that - a community. We would like to be able to share your simchas as well as provide comfort or assistance to you or a loved one who is ill. To help us accomplish that, please let us know of any important life celebration (e.g. a birth, Bar/Bat Mitzvah, graduation, anniversary) or if you or a family member is ill, by filling out this form.

May we be privileged to share in life's joys and to support each other in times of need.

If you prefer, please feel free to call the office at 693-4260 to submit information, or email office@g-h-c.org.

This information may also be submitted directly to Rabbi Stein at RabbiStein@g-h-c.org or by calling the office.

* Indicated required fields

*Person's First Name
*Person's Last Name
Hebrew Name
*Is this person a GHC member?
 yes
 no
*Description
*The Person's Phone
*The Person's Email
Preferred method of contact
 Phone
 Email
 U.S. Mail
If ill, should we add to Mi Shebarach list?
 yes
 no
*May we share this information?
 yes
 no
Submitted by:

*Your First Name
*Your Last Name
*Are you a GHC member?
 yes
 no
*Your Email Address
*Your Home Phone
Your Work Phone
Your Cell Phone Number

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move