Youth/TE Teens Registration

Groups	Temple Emanuel Member Rates*
Kadima: Grades 3-5	$60
Junior USY: Grades 6-8	$125
Senior USY: Grades 9-12	$125

DUES ARE VALID SEP 1, 2025 THRU JUN 30, 2026

*Please note: Temple Emanuel members are billed along with their membership dues. This fee includes prepayment of 7 teen Shabbat dinners throughout the year and supplementing other programs.

Online Payment of the Temple Emanuel Youth/TE Teens dues is available below for people that don’t want their dues included on their synagogue bill. Please contact Wayne for non-member dues rates.

Youth/TE Teens Registration Form: 2025-2026

Please fill out a separate form for each student

Student Name(Required)

First Last

Student Preferred Gender(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

School(Required)

Grade(Required)

DOB(Required)

Home Phone

Student's Cell Phone

Student's Email

Did they attend summer camp in 2025?(Required)

Yes

No

Name of camp:(Required)

Youth/TE Teens Member Family Information

Parent/Guardian Information

Full Name

Email

Cell Phone

Work Phone

Primary Houehold Email(Required)

Youth/TE Teens Group

Select your age appropriate group:(Required)

Medical Information

Doctor's Name(Required)

Doctor's Phone Number(Required)

Are there any special medical concerns or limitations to your child’s full participation in our youth programs?

Are there any food or drug allergies/special conditions/dietary needs/restrictions on activity/special circumstances of which the Advisors/Director should be aware?

Parent/Guardian Permission

I give my permission for my child to participate in the activities of the Youth Department. My child is permitted to use any transportation selected by the advisor and/or Director of Informal Youth Education. I give permission to Temple Emanuel and its agents to secure proper medical treatment in the event of an emergency.(Required)

Yes

I give my permission for photos to be taken of my child, and agree that they may be used for Temple Emanuel promotional purposes, including but not limited to our website and social media.(Required)

Yes

No

I would like to receive the Temple Emanuel USY e-newletter. Note that by opting out you will not receive information about upcoming events(Required)

Yes

No

Please enter Parent's/Guardian's Name(Required)

(in lieu of a signature)

Membership Agreement

As a representative of the Temple Emanuel community, I recognize my need to observe appropriate behavior at all times. I agree to be considerate of my peers and the Youth Department staff and I will follow all rules as set at the beginning of each program. While participating in a Temple Emanuel sponsored youth activity, I will follow the Jewish ritual laws regarding Kashrut and Shabbat and I will refrain from the unlawful use of drugs, alcohol and tobacco. I understand that if I don’t abide by these criteria it may result in disqualification from attending future youth events. for my child to participate in the activities of the Youth Department. My child is permitted to use any transportation selected by the advisor and/or Director of Informal Youth Education. I give permission to Temple Emanuel and its agents to secure proper medical treatment in the event of an emergency.

I agree

Please enter Youth/TE Teens member's name(Required)

(in lieu of a signature)

Please enter Parent's/Guardian's Name(Required)

(in lieu of a signature)

Convenience Fee

Price: $0.00

Total

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

2024-25 Preschool Enrollment is now open!

Community

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Learning

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Israel

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Youth/TE Teens Registration

Youth/TE Teens Registration Form: 2025-2026

Youth/TE Teens Member Family Information

Youth/TE Teens Group

Medical Information

Parent/Guardian Permission

Membership Agreement

Questions? Contact:

Wayne Goldstein

Get Started