Teen Movie Night

Join us as we end Shabbat together with Havdalah followed by a Top your Own Latke Bar and Movie Night.

We will be watching the newly released movie White Bird which is a spin-off from the movie Wonder.

Teen First Name

Teen Last Name

Teen Mobile Phone Number

Teen Email Address

Parent 1 First Name

Parent 1 Last Name

Parent 1 Mobile Phone Number

Parent 1 Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Mobile Phone Number

Parent 2 Email Address

Emergency Contact Full Name

Emergency Contact Phone Number

Relationship to Teen

Important Medical Information about my Teenager

Please utilize this space to inform Rabbi Jordan Millstein and Sarah Donsky about any important medical information for your Teenager, such as allergy information or any other medical information that may impact them throughout the event.

Please note that if your child requires medication to be administered at any point during the duration of this event or carries emergency medication with them such as an EPI-PEN, you will be sent a permission form to complete authorizing the Temple Sinai staff to administer said medication as prescribed be your child's doctor.

All information provided will remain confidential between you, the Temple Sinai staff outlined above, and any additional personnel that you consent to being informed.

Additional Important Information about my Teenager

Please utilize this space to inform Rabbi Jordan Millstein and Sarah Donsky about any important information for your Teenager that may impact them throughout the event.

All information provided will remain confidential between you, the Temple Sinai staff outlined above, and any additional personnel that you consent to being informed.

Permission to Photograph

Yes, my teenager can be photographed AND be posted on Temple Sinai & Temple Emeth's Social MediaYes, my teenager can be photographed, but CANNOT be posted on Social MediaNo, my teenager cannot be photographed

Synagogue Affiliation

Temple Sinai of Bergen CountyAttending as a Guest

Parent Signature

By signing this registration form, I am granting permission for my teenager to participate in this event as outlined above. I am also granting permission to the Temple Sinai staff to act in the best interest of my teenager in the case of an Emergency.

Wed, November 6 2024 5 Cheshvan 5785

Temple Sinai of Bergen County
One Engle Street
Tenafly, New Jersey 07670
Phone: (201) 568-3035
Fax: (201) 568-6095

info@templesinaibc.org
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