Yom Kippur Youth & Families - Form - Kehal Kodesh Bene Israel Rockdale Temple

YOM KIPPUR YOUTH SCHEDULE
9:15AM - FoRT Service (Infants - 1^st graders & families)
followed by:
Interactive Family Experience
[Child(ren) with an adult]
Childcare will be available following Family Experience - $15 per child; $30 family cap

10:00AM - Youth Service (2^nd - 6^th Grade, families welcome)
followed by:
Interactive Youth Experience
(2^nd-6^th grade*)
*Parents must stay on campus during all programming.

Parent Information

Parent First Name

Parent Last Name

Parent Email

Parent Cell

Would you like to enter another parent/guardian's information?

Please Select OneYesNo

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell

Child(ren) Information

How many children are you registering today?

Child 1 Information

* Child 1 First & Last Name

* Child 1 Age

Child 1 Pronouns

optional

* Child 1 Grade

* I am registering my child for

FoRT Service (Infants-1st Grade & Families) 9:15 AMInteractive Family Experience (3yrs. old-1st grade) 10:00 AMChildcare (Infants - 1st Graders) 11:00AM-12:30 PMYouth Service (2nd - 6th Grade, Families Welcome) 10:00 AMInteractive Youth Experience (2nd - 6th Grade) 11:00 AM

Does your child(ren) have any allergies, special dietary needs, or health issues?

Child 2 Information

* Child 2 First & Last Name

Child 2 Age

Child 2 Pronouns

optional

* Child 2 Grade

* I am registering my child for

Does your child(ren) have any allergies, special dietary needs, or health issues?

Child 3 Information

* Child 3 First & Last Name

Child 3 Age

Child 3 Pronouns

optional

* Child 3 Grade

* I am registering my child for

Does your child(ren) have any allergies, special dietary needs, or health issues?

Child 4 Information

* Child 4 First & Last Name

Child 4

Child 5 Pronouns

optional

* Child 4 Grade

* I am registering my child for

Does your child(ren) have any allergies, special dietary needs, or health issues?

Child 5 Information

* Child 5 First & Last Name

* Child 5 Grade

* I am registering my child for

Does your child(ren) have any allergies, special dietary needs, or health issues?

Emergency Information

This information will only be used in the event of an emergency.

Emergency Contact Name

Emergency Contact Cell

Emergency Contact Email

Do you give consent for emergency medical treatment of your child(ren)?

YesNo

Please explain what course of action Youth Experience authorities should take if you elected not to give consent for emergency medical treatment.

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