2017-18 Temple Beth El LIBERTY Youth Group Registration Form

Welcome to Online LIBERTY Youth Group Registration!  


LIBERTY (Life In Beth El Reform Temple Youth) is for youth in grades 8-12.  The teen-elected LIBERTY board, plans, organizes and implements programs with assistance from TBE staff.  From awesome social and cultural programs to fun weekends with Jewish teens from around the Southeast, LIBERTY offers teens the best way to get involved, make life-long friendships and set the course for their own Jewish journeys!  The membership fee to join LIBERTY is $65 per person .  Membership is required to participate in any LIBERTY event.  Please do not let cost be a barrier to joining LIBERTY.  We are happy to discuss financial assistance with your family.  If you have questions, please contact Sam Swire at 704-749-3049 or email sswire@templebethel.org.


An "*" indicates a required field.  If this field is not relevant to your family, type "NA."
PARENT INFORMATION











Reminder: "*" indicates required field. If this field is not relevant to your family, type "NA."

Reminder: "*" indicates required field. If this field is not relevant to your family, type "NA."








YOUTH INFORMATION

Reminder: Only fill this section out if registering a child in K - 2nd Grade.



MEDICAL INFORMATION & RELEASE
Please complete the answers to the following questions for all children being registered.  Your answers are held in complete confidence with the Director of Education.  Being as honest and thorough as possible allows us to provide the best environment for your child(ren).







PERMISSION FOR EMERGENCY MEDICAL TREATMENT - Please complete all information.
An "*" indicates a required field.  If this field is not relevant to your family, type "NA."





I/we will indemnify, save harmless and defend Temple Beth El, its officers, directors, agents, and employees, from all liability from loss, damage, or injury to persons or property in any manner arising out of or incident to the performance of this agreement including without limitation all consequential damages and/or attorney's fees.  in the event of a medical emergency and I/we cannot be reached, I/we hereby give permission to the physician selected by the Temple agent to hospitalize and secure proper treatment for my child(ren) as named herein.




EMERGENCY CONTACTS
In the event your child becomes ill or injured at school and we are unable to reach a parent, please provide two local emergency contacts other than parents.  We will always attempt to reach parents first.








PUBLICATIONS & PHOTOS
Temple Beth El may publish individual photos/videos of your child(ren) in Temple Beth El publications, in CJN or other newspapers, on the website, or other social media with secure and restricted public access, and on school bulletin boards.  If you DO NOT wish to have your child's photograph published, please check below.  Note:  All students may appear in photos/videos that showcase whole classes or multiple student groups.
FEE SCHEDULE

LIBERTY YOUTH GROUPS:  $65 per child

PLEASE ENTER THE # OF CHILDREN AND THE FEE AMOUNT BELOW.   THE TOTAL FEE WILL CALCULATE AUTOMATICALLY AND THE TOTAL AMOUNT SHOWN WILL BE BILLED TO YOUR CREDIT CARD ENTERED BELOW.



Payment Information










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