Youth Group Emergency Contact Form

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* How many children are you registering for groups?

* First Name

* Last Name

* Preferred Name

* Birthdate:

* Grade

* Attending Youth Groups/Babysitting on which days?

Please Choose OneBoth Rosh Hashana AND Yom KippurOnly Rosh HashanaOnly Yom Kippur

* Does your child have any allergies?

Please Choose OneNoYes

If Yes, please list all allergies here.

Please list any comments or details about your child that you feel would be helpful to us in making their experience enjoyable.

* Home address

Home Phone Number

* Parent/Guardian name(s)

* Cell Phone Number

Phone 2

* Email

* Other emergency contact

Phone 1

Phone 2

* What minyan do the parent/guardian daven in?

Please list up to two people who you authorize to pick up your child from groups:

Thu, July 10 2025
14 Tammuz 5785

Today's Calendar

Shacharit

: 6:30am

Shacharit

: 8:00am

Mincha/Maariv

: 8:15pm

This week's Torah portion is Parshat Balak

Shabbat, Jul 12

Candle Lighting

Friday, Jul 11, 8:07pm

Fast of Tammuz

Sunday, Jul 13

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Thu, July 10 2025 14 Tammuz 5785