Youth/TE Teens Registration

	Temple Emanuel Member**	Non-Member
Kadima: Grades 3-5	$60	$70
Junior USY:	$70	$90
Senior USY: Grades 9-12	$90	$115

Youth/TE Teens Member Information

Please fill out a separate form for each child

First Name

Last Name

Gender

Address

Street Address Address Line 2 City State ZIP Code

School

Grade

Birthdate

Home Phone

Child's Cell Phone

Child's Email

Youth/TE Teens Member Family Information

Parent Information

Name	Email	Home Phone	Cell Phone	Work Phone

Did you attend a Jewish summer camp in 2023?

Yes
No

Name of Camp:

Did you visit Israel in Summer 2023?

Yes
No

Name/type of trip:

Are you a Temple Emanuel member?

Yes
No

Youth/TE Teens Group

Select your age appropriate group:

Medical Information

Doctor's Name

Phone #

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

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.

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.

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.

Yes
No

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

Yes
No

Please enter Parent's/Guardian's Name

(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.

I give my permissionAs 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.

Please enter Youth/TE Teens member's name

(in lieu of a signature)

Please enter Parent's/Guardian's name

(in lieu of a signature)

Youth/TE Teens Dues*

Convenince Fee

Price: $0.00

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total

$0.00

2024-25 Preschool Enrollment is now open!

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Youth/TE Teens Registration