Congregation Kol Tikvah Youth Department Enrollment Form 2011-2012/5772

PHILOSOPHY OF THE CONGREGATION KOL TIKVAH YOUTH DEPARTMENT
At Congregation Kol Tikvah, the future of Jewish youth is paramount.  Our programs in the Youth Department are designed to inspire leadership and creativity. We are committed to creating a foundation for a lifetime of curiosity and passion for Judaism. 
Contact us to learn more about our programs!

INTRODUCING OUR 2011-2012/ 5772 SEASON PASS
In keeping with our philosophy in the Youth Department, we have created a "Season Pass", one low all-inclusive price for the entire year of youth group! Your commitment and excitement for the Youth Department in our congregation has allowed us to offer our amazing programming at a much discounted rate for the year!  We hope your children will take advantage of this incredible offer and join us for a phenomenal year!  Let's get ready to PLAY BALL!
Please fill out the form below if you are interested in enrolling your child in our Youth Department.  You will be contacted by our business office for payment arrangements.

Child 1		Child 2
	*Please Choose a Youth Group Please Choose: Gr. 8-12: PARTY CHAI $754 Gr. 6-7: Jr. PARTY $154 Gr. 3-5: Bonim $136 Gr. K-2: Chaverim $118		*Please Choose a Youth Group Please Choose: Gr. 8-12: PARTY CHAI $754 Gr. 6-7: Jr. PARTY $154 Gr. 3-5: Bonim $136 Gr. K-2: Chaverim $118
Child Email		Child Email
Child Cell		Child Cell
Texting OK?	Yes:    No:	Texting OK?	Yes:    No:
Facebook?	Yes:    No:	Facebook?	Yes:    No:
	Allergies/Medications		Allergies/Medications
Child 3		Child 4
	*Please Choose Youth Group Please Choose Gr. 8-12: PARTY CHAI $754 Gr. 6-7: Jr. PARTY $154 Gr. 3-5: Bonim $136 Gr. K-2: Chaverim $118		*Please Choose Youth Group Please Choose Gr. 8-12: PARTY CHAI $754 Gr. 6-7: Jr. PARTY $154 Gr. 3-5: Bonim $136 Gr. K-2: Chaverim $118
Child Email		Child Email
Child Cell		Child Cell
Texting OK?	Yes:    No:	Texting OK?	Yes:    No:
Facebook?	Yes:    No:	Facebook?	Yes:    No:
	Allergies/Medications		Allergies/Medications
Parent 1		Parent 2
Parent 1 Cell		Parent 2 Cell
Contact Email:		Home Phone:
Texting OK?	Yes:    No:	Facebook?	Yes:    No:
Insurance		Policy #
Insurance Phone		Member of Kol Tikvah?	Yes:    No:
*Family Membership to Congregation Kol Tikvah is required for the above pricing.  Please note that additional fees may apply to non-members.
By completing this  Form, I give my permission for my child(ren), , to participate in Youth Programming for the 2011-2012/5772 year. I hold harmless Congregation Kol Tikvah, The Youth Department and/or individual Advisors that may be part of this trip if any injuries may incur in transit to/from or during the event. I give Congregation Kol Tikvah, or an agent of Congregation Kol Tikvah in an advisor capacity for the Youth Department, permission to have my child(ren) treated at a medical facility in the event of a medical emergency and I cannot be contacted. I give Congregation Kol Tikvah permission to use and publish any photographs of my child(ren) from the events. Typing your name/date below constitutes a virtual signature to the agreement above. Parent Full Name:    Date: