3rd - 6th Grade Temple Beth Torah Youth Group Registration 2016 2017
2016~2017
3rd - 6th Grade Youth Group
* Advanced sign-up is required for all events
* Dues have been included in your Religious School Registration
* Parents are required to chaperone at least one Youth group event per year.

For more information contact:
Dr. Jodi Allison Mishkin-Michaelson
Director of Youth Engagement
tembty@yahoo.com
(516)413-5122 (cell)

* Note: forms may be updated at anytime by completing a new form
* Required

Participant's First Name: *
Your answer
Participant's Last Name: *
Your answer
Participant's Grade: *
Week Day Participant Attends Religious School: *
Participants Cell Phone Number:
Note: Participants are welcome to attend either or both nights
Your answer
Participants E-mail Address:
Your answer
Parents E-Mail Address:
Your answer
Parents Home Phone Number: *
Your answer
Parents Cell Phone Number: *
Your answer
Participant Allergy Information: *
Note: if participant does not have any allergies, please write "none" in the box below
Your answer
Tuesday Night Events (3rd-6th Grade Youth Group)
Please Check events your child is interested in attending Note: Participants are welcome to attend either or both nights
Wednesday Night Events (3rd-6th Grade Youth Group)
Please Check events your child is interested in attending Note: Participants are welcome to attend either or both nights
Parent Chaperone
Parent Chaperones are integral in assuring the safety of our kids at each event and helping to ensure that each event runs smoothly. Volunteering as a parent chaperone is a wonderful and fun Mitzvah! Thank you in advance to all parents for giving your time to be a chaperone throughout this year.
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