Havurah Questionnaire

Fill out this form to participate in Beth Shalom’s Havurah program. If multiple adults in your household prefer to be in separate havurot, each adult should fill out their own Havurah Questionnaire form.

Name *

First

Last

Email *

Phone *

Give your preferred contact phone.

Name(s) of additional adults participating

Phone for Additional adult

Give your preferred contact for an additional adult.

Email for Additional adult

Name(s) of participating children, with ages

Which demographic group(s) does your household represent (you may choose more than one)? *

• Parent(s) with children ages 0-4
• Parent(s) with children ages 4-6
• Parent(s) with elementary aged children
• Parent(s) with middle school aged children
• Parent(s) with high school aged children
• Parent(s) with college-aged children
• Parent(s) with adult children
• Single person, aged 20-39
• Single person, aged 40-59
• Single person, aged 60+
• Couple, aged 20-39
• Couple, aged 40-59
• Couple, 60+

What additional demographic group(s) might your household represent, if any?

• Retired
• Grandparent
• Widowed
• LGBTQIA+
• None of the above

Which demographic group(s) would you most like to be grouped with? (Choose three) *

• Doesn’t matter to me
• Parent(s) with children ages 0-4
• Parent(s) with children ages 4-6
• Parent(s) with elementary aged children
• Parent(s) with middle school aged children
• Parent(s) with high school aged children
• Parent(s) with college aged children
• Parent(s) with adult children
• Single people, aged 20-39
• Single people, aged 40-59
• Single people, age 60+
• Couples, aged 20-39
• Couples, aged 40-59
• Couples, aged 60+
• Retirees
• Grandparents
• LGBTQIA+
• Multi-generational

What neighborhood do you live in?Squirrel Hill NorthSquirrel Hill SouthGreenfield/HazelwoodShadysideOaklandRegent SquarePoint BreezeHighland ParkFox Chapel/O’Hara TownshipOakmont/Harmar/VeronaNorthsideSouthside/DowntownSouth HillsNorth HillsEast SuburbsOther

How far are you willing to travel to other members of your havurah?Anywhere / does not matterSame neighborhoodUp to 5 miles awayUp to 10 miles awayUp to 20 miles away

What kashrut and dietary observance best describes your home?Kosher – all items have a hechsherKosher – all items have a hechsher or ingredients are kosherVegetarianVeganNot observant of kashrutKosher at home – eat out at restaurantsOther / ‘it’s complicated’Prefer not to answer

What kashrut and/or dietary restrictions would you prefer to be grouped with? (May select several)

• Nut free
• Gluten free
• Allergy sensitive
• Kosher – all items have a hechsher
• Kosher – all items have a hechsher or ingredients are kosher
• Vegetarian
• Vegan
• No preference
• Other

What degree of shabbat observance would you wish to be grouped with?Shomer shabbatFlexible – I would drive to havurah activities on Shabbat

When would you prefer to meet with your havurah?

• Weekdays – evenings
• Weekdays – daytime
• Friday evening
• Saturday day
• Saturday evening
• Sunday day
• Sunday evenings

What activities would you be interested in doing as part of your Havurah experience? (pick all that apply)

• Shared Observance – Celebrate Jewish Holidays
• Shared Observance – Shabbat Dinners
• Shared Observance – Discussion on Jewish Themes, including Torah study
• Being active together – Outdoors (e.g. hiking, nature exploration, biking)
• Being active together – Playing sports
• Being active together – Taking walks together
• Being active together – Bowling
• Being active together – Israeli Dancing
• Creating together – Cooking
• Creating together – Crafts
• Creating together – Music – performing
• Creating together – Writing
• Cultural outings – Going to museums
• Cultural outings – Going to see Musical performances
• Cultural outings – Going to see live Theater
• Cultural outings – Going to sporting events
• Games – Play board games
• Games – Play video games
• Group undertakings – Social Justice projects, including volunteering
• Group undertakings – Giving circle (pooling money for charitable giving)
• Group undertakings – Investment Club
• Group undertakings – Travel
• Hobbies – Gardening
• Hobbies -Stamp Collecting
• Kids – Play dates – activities focused on young children
• Research and Learning – Ancestry checking- genealogy
• Research and Learning – Discussion on secular themes
• Research and Learning – Exploring Jewish Pittsburgh
• Research and Learning – Reading books aka Book club

Are there additional hobbies, sports, or activities you might be interested in letting us know about?

Is there anything else we should know about regarding havurah?

If you would like to request up to two families/individuals to be in your havurah, please list them below:

Submit