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TIS Youth Group Waivers
Please verify reCaptcha before submitting the form.
Parent / Guardian #1
First Name
Last Name
*
Preferred Contact #
*
Other Contact #
*
Email address
Address
Parent / Guardian #2
First Name
Last Name
Preferred Contact #
Other Contact #
Email address
Full home address if different from Parent / Guardian #1
Youth Group Member's Information
*
First Name
*
Last Name
*
Preferred Name
*
Preferred pronouns
Birthdate
*
Grade as of September 2024
*
Student's Phone #
*
Email address
*
Address
Same as Parent / Guardian #1
Same as Parent / Guardian #2
*
Please select your youth group.
Please Select One
Machar (grades K-2)
Chaverim (grades 3-5)
Gesher (grades 6-8)
USY (grades 9-12)
Emergency Contact other than Parent
*
First and Last Name
*
Preferred Contact #
*
Other Contact #
Medical Information and Health History
*
Does your student have any allergies?
Yes
No
If yes, please list.
Do your child's allergies require an epi-pen?
Yes, and my child will self-carry at all youth group functions.
Yes, and parent will provide to staff at each youth group function (for 5th grade and below)
My child's allergies do not require an epi-pen.
Current Medications / Treatments:
Disability, chronic illness, or condition
Activity restrictions or modification:
Recent illness or surgery:
Is there anything else we should be aware of to ensure the best possible experience for your child?
Releases and Waivers
*
I give permission for my child's photo to be used on social media, the TIS website and other publicity materials (photos do not have names of children listed).
Yes
No
*
I do hereby consent and agree to the participation of my child in all activities of the Tifereth Israel Synagogue Youth Program. I state that they are in good/normal health, have no physical or mental handicaps that would interfere with full participation in the program and has my permission to engage in all available activities except as noted under restrictions or modifications above.
Yes
No
*
In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parents or guardian of the child. In the event they cannot be reached, I hereby give permission to a physician selected by the youth program, its employees, advisors, or agents to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia or surgery for my child as named above. I am aware that this form may be photocopied for use by medical caregivers.
Yes
No
*
Insurance Company Name
*
Insurance Policy Number
*
My child has my permission to be transported by bus to off-site events. I understand that my child will be accompanied by synagogue staff. I agree to release, indemnify, and hold harmless Tifereth Israel Synagogue from all responsibility during supervised activities.It is clearly understood that no smoking or drugs (other than those prescribed by a licensed physician) will be permitted on any trip. It is also understood that in the event of behavior unacceptable to the staff, parents will be notified, and the child will be sent home at the parents’ expense.
Yes
No
Tue, July 8 2025
12 Tammuz 5785
Friday Night
Candle Lighting
: 7:41pm
Shabbat Day
Havdalah
: 8:48pm
This week's Torah portion is
Parshat Balak
Shabbat, Jul 12
Candle Lighting
Friday, Jul 11, 7:41pm
Havdalah
Motzei Shabbat, Jul 12, 8:48pm
Fast of Tammuz
Sunday, Jul 13
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Tue, July 8 2025 12 Tammuz 5785