TSTI Teen Program Registration Form 2022-2023 - Form

A SEPARATE FORM MUST BE FILLED OUT FOR EACH PARTICIPANT

THIS FORM MUST BE COMPLETED ONCE A YEAR AND IS VALID SEPTEMBER, 2022 - JUNE, 2023

TSTI Members are welcome to participate in a "trial run" of the first 3 sessions
of 8th grade and Hebrew High before submitting payment.
Simply login to your ShulCloud account, select "bill me later" at the end of this form.

* PERMISSION TO PARTICIPATE

PERMISSION TO PARTICIPATEBy checking this box I give permission for my teen to attend TSTI programs and events.

Contact Information

* Teen First Name

* Teen Last Name

* Teen Grade

* Teen Email

* Teen Cell

* What pronouns does teen use?

* TSTI Membership

Will teen attend camp this summer, and if so what is the name of the camp(s)?

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

* Parent 1 Cell

Parent Home Phone

* Parent 1 Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell

Parent 2 Home Phone (If different than above)

Parent 2 Address (If different than above)

* In case of emergency, please notify (other than parents)

* Emergency Contact Relationship

* Emergency Contact Phone #

Medical Information

* Medical Insurance Company

* Policy #

* Allergies and Special Dietary Needs

If yes, please list all Allergies and Special Dietary Needs

List non-food allergies:

* Does your teen use an EPI-PEN?

If yes, please know they must carry it with them at all times.

List any specific medical information we should know about, including any disability accommodations your teen requires to participate fully in our programs.

List any medications your teen will be taking while participating in TSTI events. Please include: medication name, dosage, timing, reason for medication, potential side effects. Also, please indicate if your teen will need reminders to take their medication, and/or if you prefer that staff hold the medication rather than your teen.

* I hereby authorize the emergency physician to provide emergency medical treatment to my child for: a. any laceration, fracture, or other traumatic injury; or b. any symptom, disease, or injury that may be life threatening, disfiguring, or cause permanent impairment. No major surgery or life-threatening procedure may be performed on my child and no general anesthesia may be administered unless: a. The life or health of my child is in danger or if delaying such treatment to obtain consent would cause a threat or serious injury to the health of my child; and b. the attending physician and one other physician consult and agree that such a treatment is necessary for the health of my child.

Vaccination Records

* TSTI requires all K-12 students to be up to date on all of their routine age-appropriate vaccinations and booster shots, including for COVID-19. Students who are not fully vaccinated will not be permitted to enroll. Is your child fully vaccinated?

* TSTI strongly encourages all K-12 students to receive an annual flu vaccine. Please consider making plans accordingly. Check this box to indicate your understanding.

TSTI strongly encourages all K-12 students to receive an annual flu vaccine. Please consider making plans accordingly. Check this box to indicate your understanding.

* Please upload a picture of your teen's COVID-19 vaccine record here. (image of state-issued card, screenshot from Docket, etc.)

Please upload a picture of your teen's vaccination record here. This can be obtained from your family's doctor.

* I, along with my teen, agree to abide by the TSTI COVID-19 policies as stated on the Temple website. I understand that these policies are updated regularly to reflect current medical guidance.

I, along with my teen, agree to abide by the TSTI COVID-19 policies as stated on the Temple website. I understand that these policies are updated regularly to reflect current medical guidance.

Publicity Release

* Temple Sharey Tefilo-Israel has permission to use photos/video of my teen in local publications, social media, and the Temple Sharey Tefilo-Israel website.

Code of Conduct

I will promote the creation of a religious youth community based on mutual respect and a sense of personal well-being. I will treat others with kavod (honor and respect) because we are all created b'tzelem Elohim (in the image of God). I have read the following rules, designed to promote the health and safety of all event participants, and have indicated my unqualified acceptance by my signature and that of my parent/guardian.

I will not possess, consume, or distribute alcoholic beverages.
I will not possess, use, or distribute any illegal drugs or drug paraphernalia.
I will not smoke, or use tobacco products, vape or possess or use electronic cigarettes.
I will attend and participate fully in the entire event, unless otherwise agreed upon with the TSTI staff. I will arrive on time, stay until the end, and remain on the event premises at all times.
I will not bring or use any weapons, firearms, or anything that may be construed as a weapon.
I will not commit any illegal act. I understand that vandalism, disturbing the peace or other inappropriate behavior as determined by the TSTI staff or Temple Clergy will not be tolerated. I understand that I will have to pay for any damage that I cause.
I understand that no gambling is allowed.
For overnight events, I will abide by the event curfew announced by the TSTI staff or Temple Clergy. I will go to my room at curfew and remain in my room until the next program is scheduled.
I understand that no guests are allowed at any event, unless permission is granted in advance by the TSTI staff or Temple Clergy, and that any unauthorized guests will be asked to leave immediately.
I will not participate in any activities that could be deemed as hazing, sexually harassing, demeaning or hurtful.
I agree to refrain from inappropriate sexual behavior.
I understand that at any time I may be asked to leave by the TSTI staff or Temple Clergy.
I agree to abide by any additional rules, pertinent to the specific event, which may be announced, and to accept the consequences of their violation. I understand that these rules of behavior apply from the time I leave home for the event, during the event itself, and until I return home after the event.I understand that signing this form constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

* Teen's Signature (By typing your name below, you verify acceptance of the guidelines listed above, showing you fully understand them and that you are willing to abide by them.)

Full Name

* Parent's/Guardian's Signature (I understand that typing my name below constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.)

Full Name

Program

Complimentary Youth Group Membership (STISY Only) - 9th-12th Grades8th Grade ProgramHebrew High School - 9th-12th Grades - Includes Complimentary Youth Group Membership (STISY)Madrichim program (8-12th grades) - Includes Complimentary STISY membership. (NOTE: This is a paid teacher's aide position and requires approval from the RS Director)Updating Information Only - Student Previously Registered for 2022-23 School YearHebrew High Trial Only

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Program

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