High Holiday Youth Program Registration - 5783 - Form - Beth Jacob Congregation of Irvine

Parent/Guardian Information

* First Name

* Last Name

Address

City

State

Zipcode

* Email

* Relationship to participant(s)

* This adult will be attending the following minyan:

Please Select OneHashkamaAshkenaziSephardi

Additional Authorized Adults

I give permission to the following adults to check-in/out my children:

Adult #1

Full Name

Phone Number

Relationship to participant(s)

Minyan

AshkenaziSephardiHashkama

Adult #2

Full Name

Phone Number

Relationship to participant(s)

Minyan

AshkenaziSephardiHashkama

Participant Information

Participant #1

* First Name

* Last Name

* Age

* Grade

* For which holidays

Rosh HashanaYom Kippur

Participant #2

First Name

Last Name

Age

Grade

For which holidays

Rosh HashanaYom Kippur

Participant #3

First Name

Last Name

Age

Grade

For which holidays

Rosh HashanaYom Kippur

Participant #4

First Name

Last Name

Age

Grade

For which holidays

Rosh HashanaYom Kippur

Participant #5

First Name

Last Name

Age

Grade

For which holidays

Rosh HashanaYom Kippur

Additional Information

Please provide us with any additional information you believe will help to ensure your child has a positive High Holiday experience at Beth Jacob of Irvine (i.e. allergies, medical, or behavioral concerns).

* Number of Children (Non-Member)

If you are a member - please log in.

Child Under 2

Total Payment

All forms will be returned with the most current and accurate information no later than September 14th, 2022 and all fees are paid.
A parent or authorized adult must register, drop off, and pickup child(ren) within the designated times.
A parent or authorized adult must remain on the Beth Jacob campus and be available while the child(ren) are participating in the youth program.
Electronic devices (including but not limited to phones, tablets, electronic games, music players, etc) are not permitted in the Youth Program.
If a child repeatedly misbehaves (being disrespectful, going into the areas that are not allowed, or physically hurting others, etc), a parent will be notified. If the problem persists, the child will be escorted to a parent and will not be permitted to return to the Youth Program for the duration of the services.
Parents are responsible for notifying staff of all allergies, dietary restrictions, and/or medical or behavioral concerns.
Children who are registered for the program are required to be in the space provided or with their parents.
Age 2-K: if a child is crying and cannot be consoled after 5 - 10 min., the parent will be notified.
If a child is tired, hurt, or feels like he/she needs to talk to a parent, the child will be brought to the parent or the parent will be informed of the situation.
A light snack of prepackaged items will be provided for all age groups. Lunch is the sole responsibility of the parents, and will not be provided as a part of the program.

Participant and parent/guardian specifically assume all risks of injury arising out of his/her participation in all BJI Youth Programs during the 5783 year whether at the BJI campus or another location. I hereby waive, release and agree to hold free from all claims for damages Beth Jacob Congregation of Irvine and NCSY and its offices, directors, members, employees, or agents. I will only participate in activities for which I or my child/teen are physically capable and agree not to participate in any activity that may injure myself or others.

I hereby give permission for my child/teen to be photographed by BJI, NCSY or their representative on non-Shabbat and Holiday times. These photographs may be used in publications, including electronic publications, or in audio-visual presentations, promotional literature, advertising, or in other similar ways.

* I understand that by submitting this form, I agree to follow the Beth Jacob Congregation of Irvine (BJI) High Holiday Youth Program guidelines.

I understand that by submitting this form, I agree to follow the Beth Jacob Congregation of Irvine (BJI) High Holiday Youth Program guidelines.