Temple Israel Youth Membership

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Temple Israel Youth Membership

Shalom Temple Israel Families! Make sure you are a part of all the fun this year!
Regardless of interests or age, there is FUN for EVERYONE!!!

*Please DOWNLOAD the EMERGENCY MEDICAL RELEASE and bring the completed form/s to your first event*

Child's First Name

Child's Last Name

Child's D.O.B.

Street Address

State

Zip Code

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

Child's First Name

Child's Last Name

Child's D.O.B.

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

Child's First Name

Child's Last Name

Child's D.O.B.

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

Child's First Name

Child's Last Name

Child's D.O.B.

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

Child's First Name

Child's Last Name

Child's D.O.B.

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

Child's First Name

Child's Last Name

Child's D.O.B.

Secular School Name

Grade

Student's Mobile # (5th-12th grade, if applicable)

Student's Email (5th-12th grade, if applicable)

MAHAR (3rd-5th Grades) - $18

MAHAR - TIRS students

KADIMA (6th-8th) - $18

IR HA-MALKA (9th-12th) - $36

Yes! I would like to make an OPTIONAL DONATION (please enter amount) to the Stuart F Ostrow Youth Fund to help ensure that all children may attend.

Parent/Guardian #1 - First Name

Parent/Guardian #1 - Last Name

Parent/Guardian #1 - Mobile

Parent/Guardian #1 - Email

Parent/Guardian #2 - First Name

Parent/Guardian #2 - Last Name

Parent/Guardian #2 - Mobile

Parent/Guardian #2 - Email

** 4-YEAR USY MEMBERSHIPS ARE AVAILABLE - Sign up below **

4-Year USY Membership - TI Youth Members ($118)

4-Year USY Membership - Non-Members ($180)

Total

Thu, February 2 2023 11 Shevat 5783