Quality time with your friends and GARY doesn’t have to end with Confirmation! Back by popular demand!
11th and 12th graders are invited to participate in monthly small group conversations around the dinner table to delve deeper into their Jewish identities, wrestle with existential questions and strengthen their Jewish community. Meetings will be scheduled at Temple Beth Am, participants’ homes or local restaurants.
Your First Name
Your Last Name
Please indicate 11th or 12th Grade
Your Email Address
Your Cell or Contact Phone
Parent/Guardian Daytime phone
Parent/Guardian Cell phone
Release of Liability and Authorization of Medical Treatment
I hereby grant permission for my teen to participate in all Temple Beth Am youth programs, activities and events. In consideration for Temple Beth Am’s permitting my teen to participate in these programs, activities and events, I hereby release and discharge Temple Beth Am, its officers, directors, employees and members, and each of their respective agents, successors and assigns, from all claims, actions or demands on account of any injury or loss that may arise in connection with these programs, activities and events. If my child should sustain any injury during these programs, activities and events, I hereby grant Temple Beth Am permission to deliver my teen for treatment.
Please check the box below
Medical Insurance Company
Name of Insured
Doctor’s Phone Number
Special Medical Requirements, Conditions, Allergies, Limitations and/or Medications
Emergency Contact Name
Temple Member Registration Fee - $250
Non-Member Registration Fee - $300
CVV (3 digit for Visa/MC and 4 digit for AMEX)
Name (As it appears on card)
Billing Apt., Suite, etc.