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NFTY x TBA High 2023

10/14- 3 pm-7pm
Kick Off Event for 8th-12th grade Jewish Teens!
Temple Beth Ami
*Will take a bus to Sky Zone as a portion of the event
*Pick-up and drop-off will both be at Temple Beth Ami
*Contact Alyssa Katon with questions or for scholarship information

Student Information
Please complete the fields below for EACH student attending

Healthcare Insurance

Emergency Contact Information: Parents will always be contacted first. Please list an adult other than Parent 1 or 2.


Waiver: Electronic Signature Required

I hereby authorize future communications via mail, email, text and phone for the purposes of transactional communications as well as marketing communications for this and other URJ/NFTY/NFTYx programs. Please know that we do not sell or market email addresses. If you do not wish to receive further communications from the URJ and URJ affiliates you will be able to opt out at the time of receipt.

I authorize the use of Student name, social media user information, and contact information for purposes of URJ and URJ partners/affiliates marketing now known or hereafter devised, worldwide in perpetuity until such time that I choose to unsubscribe.

I consent to the recording, use and reuse by the Union for Reform Judaism (“URJ”) and any of its respective licensees, assignees, parents, subsidiaries or affiliated entities and each of the respective employees, agents, officers and directors (collectively “Releasees”) of the Student’s voice, actions, likeness, name, appearance and biographical material (i.e. collectively “Likeness”) in any and all media now known or hereafter devised, worldwide in perpetuity. I agrees that Releasees may use all or any part of their Likeness, and may alter or modify it regardless of whether or not the attendee is recognizable. I  further agree that Releasees may use the Students Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement for the Releasees. I releases Releasees from any and all liability arising out of their use of the Student’s Likeness and/or the Materials. I agrees not to make any claim against Releasees as a result of the recording or use of the Partcipant’s Likeness and/or the Materials (including, without limitation, any claim that such use invades any right of privacy and/or publicity).

By signing below, parent or guardian on behalf of each Student and all parties responsible for Student, confirms that they have read and understood the 
NFTY B’rit Kehillah, and the rules including those on disciplinary action and indemnification expressly provided immediately above, and agree with all provisions contained herein.


Student’s Parent/Guardian gives permission to Temple Beth Ami to provide routine health care and seek emergency medical treatment including but not limited to ordering x-rays and routine tests. Student’s Parent/Guardian gives permission for Temple Beth Ami to release any of Student’s records necessary for insurance purposes.

In case of Student’s medical emergency, the Student’s Parent/Guardian hereby gives permission to the physician selected by Temple Beth Ami to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for Student, as named above. Information may be printed/photocopied for access in an emergency involving Student.

Except with the respect to the sole negligence of the Temple Beth Ami and its employees, the undersigned Student’s Parent/Guardian hereby release, discharge, and hold harmless Temple Beth Ami and their employees from any and all claims, lawsuits, or other legal causes of action, which relate to the undersigned Student’s participation in a Temple Beth Ami Program, and the Student’s travel to and from Temple Beth Ami, such events and programs, and related activities


Terms and Conditions Agreement:
The below Terms and Conditions between Temple Beth Ami and my child (hereafter “Student”) represent the expectations and agreements to participate in a Temple Beth Ami-sponsored activity:

In the mutual interests of Temple Beth Ami, the Student, and for the well-being of all Students at Temple Beth Ami, I understand, respect and will observe the rules, regulations, and policies of Temple Beth Ami, which have been developed for the benefit of all Students including Student to strengthen the Temple Beth Ami program and enhance the experience for all Students. As parent/guardian of Student, I agree to the implementation and enforcement of the following rules, regulations and policies for Temple Beth Ami program.

Tue, September 26 2023 11 Tishrei 5784