Teen Registration & Permission Form for Love Our Neighbors Service Day
Join us for a morning of community service, where teens will lead and volunteer on projects to benefit students and families at the Wilson School, in Framingham, MA.

This form should be filled out by 6th-12th graders & a parent/guardian.
Email address *
I acknowledge that the participation of my child (listed below) in Love Our Neighbors Service Day is voluntary and may result in personal injury or property damage. I understand and assume, on behalf of my child, all risks relating to participation in this event and agree that Jewish Teen Initiative of Greater Boston (JTI) and its employees, directors, officers, agents, representatives, independent contractors, licensees and sponsors (collectively, the “Releasees”) shall not be responsible for any personal injury, property damage and/or other loss suffered as a result of my child's participation in any of the individual activities (an “Injury”). I understand by signing below on behalf of my child, and in consideration of being permitted to participate in the volunteer activities, I forever release each of the Releasees from any and all liability arising from an Injury. *
Child participating in Love Our Neighbors Service Day *
Type your child's first and last name
Your answer
*
Type your name to sign
Your answer
I hereby empower JTI staff to act for me in accordance with their best judgment in case of emergency. I hereby authorize the physician selected by a JTI staff person to hospitalize, secure proper treatment for, and order injections, anesthesia or surgery for my child named above. I have also read and signed the Code of Conduct and witnessed my child signing it. *
Find the Code of Conduct on our main Love Our Neighbors page.
I understand that my child's picture may be taken at this event, and that it may appear on the JTI website, social media or in a brochure *
Would the participant named on this form like a teen buddy at this event to make the event more inclusive and responsive to their needs? https://jewishteeninitiative.org/programs/fellowship/meet-rpi-cohort2/
Participant’s Last Name *
Your answer
Participant’s First Name *
Your answer
Home Address *
Street, Town, State and Zip Code
Your answer
Participant email address *
Your answer
Birthdate *
Your answer
High School Graduation Year *
School Name *
Your answer
School Type *
Synagogue affiliation (if any) *
Your answer
Participant's cell phone number
Your answer
Participant's home number
Your answer
Parent/Guardian 1 Name *
Your answer
Parent/Guardian 1 cell phone number *
Your answer
Parent/Guardian 2 name
Your answer
Parent/Guardian 2 cell phone number
Your answer
Parent email addresses
Separate multiple addresses with a comma
Your answer
Emergency Contact (if Parent/Guardian 1 & 2 are unreachable) *
Contact name & relationship to teen
Your answer
Emergency Contact Phone Number *
Your answer
Participant's Primary Care Physician's Name
Your answer
Participant's Primary Care Physician's Phone Number
Your answer
Participant's Insurance Company
Your answer
Are there any special medical or dietary concerns or limitations to your child’s full participation in our youth program? (All information is completely confidential.)
Your answer
For 9th-12th graders only: are you interested in being a teen leader during this event?
What sort of project are you interested in? *
Please note we do not guarantee project assignment but we will do our best
Required
Signature of Parent or Guardian *
Type your name below to sign
Your answer
How did you hear about this event? *
Required
Important next steps - your registration is not yet complete
Thanks for signing up, we're so excited to work with you! In order to complete your registration, you must complete both this form and our Code of Conduct, available on our main Love Our Neighbors Service Day page.

We'll see you on Sunday, October 27, at Temple Beth Am, Framingham!
Submit
Never submit passwords through Google Forms.
This form was created inside of Jewish Teen Initiative of Greater Boston. Report Abuse - Terms of Service