Youth Group Registration

Temple Beth El Youth Groups
Shalom Temple Beth El Families!

Make sure you are a part of all the fun this year!
No matter what interest or age group, there is fun for every kid!


Registration for any of our youth groups is now available online! 
Please fill out the form below to begin the registration process.  You may fill out one form per family.  On the "Youth Signature" line, please list all of the children who you are registering for membership in TBE youth groups.

Once you have completed this form, please visit our ONLINE PAYMENT PAGE to complete your online registration.


Your online "Parent Signature" on this form indicates agreement with the following:

I will indemnify, save harmless and defend: Temple Beth El, its officers, directors, agents, and employees, from all liability from loss, damage, or injury to persons or property in any manner arising out of or incident to the performance of this agreement including without limitation all consequential damages and/or attorney’s fees. In the event of a medical emergency and I cannot be reached, I hereby give permission to the physician selected by the Temple agent to hospitalize and secure proper treatment for my child as named herein.

 
Student Name:
Date of Birth:
Secular School Grade 10-11:
Religious School Grade 10-11:
Student Name:
Date of Birth:
Secular School Grade 10-11:
Religious School Grade 10-11:
Student Name:
Date of Birth:
Secular School Grade 10-11:
Religious School Grade 10-11:
Student Name:
Date of Birth:
Secular School Grade 10-11:
Religious School Grade 10-11:
Street Address:
City, State:
Zip Code:
Student's(s') E-mail(s) (if applicable):
Parent/Guardian 1 Name:
Parent/Guardian 1 Email:
Parent/Guardian 1 Home Phone:
Parent/Guardian 1 Work Phone:
Parent/Guardian 1 Cell Phone:
Parent/Guardian 2 Name:
Parent/Guardian 2 E-mail:
Parent/Guardian 2 Home Phone:
Parent/Guardian 2 Work Phone:
Parent/Guardian 2 Cell Phone:
Medical Insurance Carrier Name:
Subscriber Name:
Subscriber Number:
Emergency Contact Name/Relationship:
Address:
Phone:
Parent Signature:
Date:
Youth Signature(s):
Date:
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