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Instructor: Madelyn Fass

Participants: Ages 5 to 7

Class dates: February 18, 25, and March 3, 10

Time: 2:00 PM to 3:30 PM

$15/members and $20/non-members per class

 

There is a minimum of 10 enrollments to make this class. If, after enrolling, the class does not make the required number, registration payments will be refunded.

Please note: there are 2 forms to fill out below. One is for Information & Consent, required for all Tiferet youth programs, and the other is the registration specifically for this class. You will receive each submission via email. Please keep the emails for your records. If you have filled out this youth program form before, you do not need to do it again

You will receive a copy of this form by email. Please keep it for your records.

CHILD'S INFORMATION

Enter in same order as English names if more than one child. Enter 'Unknown' if applicable.
Please enter in same order as English names if more than one child.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and explain.
Please list name(s) of child(ren) if applicable and enter details.

PARENT'S INFORMATION

IN CASE OF EMERGENCY

AGREEMENT

The parent(s) of the child(ren) listed above, hereby consent(s) to his/her/their participation in Tiferet Israel’s Youth Program, with the understanding that they and their child(ren) will abide by the rules and regulations of the congregation and these programs. We also agree to give notice in advance if our child will be picked up at the end of an activity by anyone other than ourselves or if they have permission to go home with another child’s family.

WAIVERS

I/we hereby authorize Tiferet Israel and its employees and agents to act as my/our agent to consent to or arrange any emergency medical treatment that may be deemed necessary by an attending physician with respect to any illness or injury suffered by my/our child(ren) on said activity.

I/we hereby give permission for my child(ren) listed above to join the Tiferet Israel Youth group for activities sponsored by Tiferet Israel. I understand they will travel by bus, van, or private car and be accompanied by staff and parents. I release Tiferet Israel Congregation synagogue from all responsibility during supervised activities. It is understood that in the event of behavior unacceptable to the staff, parents will be notified and the child(ren) will be sent home at the parents' expense.

I/we give permission to Tiferet Israel to use any photographs taken of my/our child(ren) in Tiferet Israel publications and advertising.

 

REGISTRATION FOR CLASS

   February 18
   February 25
   March 3
   March 10Select number of children registering
   February 18
   February 25
   March 3
   March 10Select number of children registering

 

Mon, April 22 2024 14 Nisan 5784