Getty with Gary


Back by popular demand! Quality time with your friends and GARY doesn’t have to end with Confirmation!

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.



Student Information

Your First Name
Your Last Name
Please indicate 11th or 12th Grade
Your Email Address
Your Cell or Contact Phone

Parent/Guardian Information

Parent/Guardian Name
Parent/Guardian Email
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
Policy #
Name of Insured
Doctor’s Name
Doctor’s Phone Number
Special Medical Requirements, Conditions, Allergies, Limitations and/or Medications
Emergency Contact Name
Relationship
Cell Phone
Home Phone
Parent/Guardian Signature
Date

Total Payment
 Temple Member Registration Fee - $250
 Non-Member Registration Fee - $300
Credit Card
Card #
Expiration
CVV (3 digit for Visa/MC and 4 digit for AMEX)
Name (As it appears on card)
Billing Address
Billing Apt., Suite, etc.
Billing City
Billing State
Billing Zip

REMEMBER TO RENEW YOUR MEMBERSHIP!  •  If you have not yet renewed your membership for 2020–21, please do so at your earliest convenience. Click here for Online Membership Renewal