Bnei Mitzvah Program - Beit Rayim Synagogue

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B'nai Mitzvah program

registration form

* First Name of Bar/Bat Mitzvah Student

* Last Name of Bar/Bat Mitzvah Student

* Bar/Bat Mitzvah Date

* Phone Number

* Email Address

* Are you a member of Beit Rayim Synagogue?

* Are you celebrating your Bar/Bat Mitzvah at Beit Rayim Synagogue?

* Child Participation Consent Form

Child Participation Consent FormBR and its representatives take great effort and precautions to assure the safety and welfare of your child. In the event of a health-related incident we will contact you immediately at the phone numbers you provide below. The undersigned understands, agrees, represents and warrants to BR that: 1. I am the parent or legal guardian of the child/children listed below. 2. BR, its directors, officers, employees and volunteers shall not be responsible for any and all claims for damages arising as a result of any accident, injury or otherwise sustained by the child/children arising from participation in any BR activities. 3. I permit my child/children to participate in each BR activity(s) that she/he/ they attend(s). 4. BR officials may act on my behalf in case of emergency. 5. Any special medical issues, allergies, special needs or other concerns that BR ought to be aware of are listed in the above registration form. By checking this box you confirm that you, as a parent/guardian of the child/ren, have read and agree to the terms and conditions above.

* Photo Consent

YesNoBeit Rayim Synagogue and School may take photographs or videotapes for use in promotional materials. We do not post names with the pictures. Please indicate if you agree to this for your child(ren) by checking the box below. By checking yes, you give your consent for photographs or videotape of you and/or children child(ren) to be used by Beit Rayim Synagogue and School for promotional purposes. By selecting No,you do NOT give consent for photographs or videotape of you and/or your child(ren) to be used by Beit Rayim Synagogue and School for promotional purposes.

* Allergies and Medical

YesNoPlease indicate if your child has any allergies or medical conditions that require our attention.

* What type of participation would you prefer?

Total Cost:

* We will be sending out multiple emails with regards to program updates, upcoming events, and so on. Which email would you like us to send this information to?