PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

- Club 4-5 is The Temple-Tifereth Israel's youth group for students in 4th-5th grade. - Junior Youth is The Temple-Tifereth Israel's youth group for students in 6th, 7th, 8th grade. - Temple Teens is The Temple-Tifereth Israel's youth group for students in 9th-12th grade. - All Youth and Teen events are open to community members and friends.

* I hereby grant permission for my son or daughter to participate in The Temple Tifereth Israel Youth Group activities. This permission includes transportation to and from events by car or bus and spending the night at The Temple or a facility approved for events.

* This health information is correct as far as I know, and the person herein described has permission to engage in all planned activities, except as noted on this application.

Agree
Need to Discuss

* In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for 1) the administration of any treatment deemed necessary by a licensed physician or dentist and 2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

* IF YOU DO NOT GIVE CONSENT...In the event of illness or injury requiring emergency treatment, I wish the supervisors of the program to take the following action (type NA, if you DID give consent)

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Temple Youth and Teen Events

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Temple Youth and Teen Events

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Image Preview