Youth Group Application | Religious School

PLEASE NOTE: YOU MUST FILL OUT ONE FORM PER CHILD YOU ARE REGISTERING.

Youth Group Registration Form

Parent/Guardian first, last name

Phone

Alternate phone

Street Address

Street Address Line 2

City

State

Zip Code

The term affiliation means you have a registered membership and are

current in your financial obligation with either Temple Beth Tikvah, Congregation Shalom Bayit or Chabad.

When enrolling participants, please include the best email address and phone number for contact, whether student's or parent's/guardian's.

Child's first and last name

Birthday

Best contact phone

Best contact email

Child's doctor

Doctor's phone

Emergency contact name

Emergency contact phone

Emergency contact relationship

Does your child have any allergies, medical issues or food restrictions?

yes

If yes, please explain below:

Dues for 2023-2024 are $50/participant + any optional donation you wish to make to our youth group (7th graders enrolled in religious school do not need to pay dues, as they are included in school tuition, enter 0.)

Thank you!

We'll be in touch.