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Temple Youth and Teen Events

Online registration and payment for participation in upcoming events.

- 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.

Fee Options 1

January 12, 2020 - Slime Making at The Temple, 12:00pm - 2:30pm $20.00

March 1, 2020 - Hands on Pottery, 12:00pm - 2:30pm $20.00

* Name of Participant

* Current Grade

* Home Phone

* Student cell phone (with area code)

* Student email

IN CASE OF EMERGENCY CONTACT

* Name

* Home Phone

* Cell Phone

* Relationship to Participant

* 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.

Yes

Please check off any dietary restrictions

Vegetarian

Kosher

No Meat and Milk

Lactose Intolerant

N/A

* Please list any allergies to medication, foods or asthma and indicate treatment

* List any medications which must be taken during the day or at night

* My child has no physical or emotional problems that may be aggravated by attendance at youth group events.

Agree

Need to discuss

* 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.

Yes

* 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)

* I volunteer to drive kids from The Temple-Tifereth Israel to the event location.

Parent Signature

Account Details

E-mail

Enter your name and e-mail address for your confirmation

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

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Increase the payment amount by 3% to cover credit card fees (No fee for Checking)

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