TBT's 7th - 12th Graders
Visit us on the web at: http://www.tbtny.org/learning
@ Adventure Park Long Island
Registration and Payment Form
75 Colonial Spring Road
Wheatley Heights, NY 11798
Date & Time:
Thrusday,September 28, 2017 from 5:30-8:30 pm
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Participant's Grade for the 2017 - 2018 School Year *
Participants Date of Birth *
Your answer
Participants Cell Number *
Your answer
Participant Allergy Information *
Write none in the box if the participant has no known allergies
Your answer
Emergency Contact Info *
Please write a name, relation, and phone number for an emergency contact for the day of the trip
Your answer
Parent Cell Number *
Your answer
My son / daughter will be joining TBT at Adventure Park Long Island Thrusday, September 28, 2017 from 5:30-8:30 pm. I confirm that I am responsible to provide transportation to and from the event and all the fees associated with the event. *
See Pricing Above: Includes entrance fees and pizza dinner
I am a parent who will be attending West Hollow MS Back to school night on Thursday, September 28th and need to pick up after 9 pm.
Need More Information?
Dr. Jodi Mishkin-Michaelson
Director of Youth Engagement
TEMBTY@yahoo.com  / 516-413-5122
Rabbi Wiesenberg 
RABWEEZ@gmail.com /631-643-1200 X328
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