Teen Trip to NY 11.17 - Form - Temple Sinai of Bergen County

Sunday, November 17 Start: 11:00am at Temple Emeth (1666 Windsor Road Teaneck, NJ 07666)
End: approx. 4:15pm at your home Synagogue

Join us as we explore the Lower East Side. Tour the Tenement Museum and enjoy a tasty Food Tour.
Lunch at the Yonah Schimmel’s Knish Bakery

We are looking for parent volunteers to chaperone and drive teens. Please indicate if you are interested when registering.

Registration: Full Year Al-HaDerekh/On the Road Participants: No Additional Charge

Participants only attending this trip: $30

Included in cost: Museum Admission, Lunch, transportation & staff supervision

It is recommended that teens bring $30-$40 for spending money at the museum and for goodies throughout the food tour.

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, Rabbi Steven Sirbu 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 trip.

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

All information provided will remain confidential between you, the Temple Sinai & Temple Emeth 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, Rabbi Steven Sirbu and Sarah Donsky about any important information for your Teenager that may impact them throughout the trip.

All information provided will remain confidential between you, the Temple Sinai & Temple Emeth 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

Permission to Use WhatsApp

YesNoWith permission, we would like to utilize WhatsApp to create a Teen Group Chat monitored by the Temple Sinai & Temple Emeth Staff to ensure we are staying in communication with the teens throughout the duration of this trip.

Chaperone Volunteer

YesNoWe are asking for parent chaperons to assist in driving the teens to and from New York for this trip.

Please indicate if you are interested in volunteering.

Name of Parent Volunteer Chaperone

Synagogue Affiliation

Temple Sinai of Bergen CountyTemple EmethAttending as a Guest

Participation

My Teen is registered for the Full Year of Al-Haderekh.Single Trip Participation

Registration: Full Year Al-HaDerekh Participants: No Additional Charge

Participants only attending this trip: $30 Included in cost:

Please contact Sarah Donsky to complete Al-Haderekh Registration if this has not been completed yet. Failure to complete this registration prior to Friday, November 15th will result in a charge of $30 for this trip.

Parent Signature

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