Number of Tickets
0 1 2 3 4 5 6 7 8 9 10 Number of Tickets
Number of Tickets * Grade (or adult)Please Select One 5th 6th-8th 9th-12th Adult Family
* REMINDER FOR 5TH GRADERS!
There must be a special chaperone specifically for the 5th graders (1 chaperone per 4 kids). Please make sure that the chaperone for your 5th grade child has volunteered and will be signing up online (5th grade chaperones must pay to attend). If, at the end, there is no chaperone, we will issue you a credit on your account towards other Beth Sholom programming.
As we grow and expand our chapter, we will need help from parents to ensure a model of appropriate supervision at USY and Kadima events. We are therefore asking for parent volunteers to chaperone to ensure a safe and fun experience. Please indicate below if you can volunteer for this event, and we will get back to you at your confirmation email address to confirm. Thank you!
In an effort to keep costs to each participant down, we are asking families to carpool to Great Adventure. Please indicate if you plan on attending or if you can drive either one way or both ways. We will be in touch as it gets closer to arrange carpools.
Permissions
I agree to waive all rights and claims against Congregation Beth Sholom and their agents and employees which may arise out of my son/daughter’s participation. I understand that my son/daughter’s participation may involve transportation in private vehicles to which I consent. I understand and agree that Teaneck Kadima/USY Youth Programs has no liability if my child travels to an event in any vehicle not provided by Teaneck Kadima/USY Youth Programs.
I certify that I understand my son/daughter’s participation in Youth programs can involve rigorous physical activity, and I further certify that my son/daughter is in good physical condition, and that my son/daughter has no medical or physical conditions that would
restrict my son/daughter’s participation.
In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parent(s) or guardian of the child. In the event they cannot be reached, I hereby give permission to a physician selected by the youth program, its employees, advisors or agents, to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia, or surgery for my child as named above. I am aware that this form may be photocopied for use by medical care givers.
I hereby grant permission for Congregation Beth Sholom to use my child’s name, likeness or
photograph in any publication, advertisement, display or other medium in connection with the programs, activities and events of Congregation Beth Sholom.
Note: pictures will be taken at the event and may be used in Beth Sholom social media (website, facebook, etc). By clicking on the "submit" button below, I am giving Beth Sholom permission to use this registrant's picture