Mini Golf with Rodeph Sholom Youth!

Mini Golf with 8th Through 12th Grades!

* Child's First Name

* Child's Last Name

Child's Grade

Child's Age

Child's cell phone (if available)

Child's Email Address (if available)

Do you have more than one child attending this event?

* Child's First Name

* Child's Last Name

Child's Grade

Child's Age

Child's cell phone (if available)

* Last Name

* First Name

* Last Name

* Email

Mobile Number

Are you a member of Rodeph Sholom?

NoYes

* Permission to Attend

By placing my name here permission is hereby granted by the undersigned parent(s) or guardian(s) for my child(ren) to attend the event at Congregation Rodeph Sholom.
I understand that field trips and other activities will be supervised, and that transportation, when needed, will be provided by one or more members of the Congregation Rodeph Sholom staff and/or parent volunteers, and that reasonable efforts will be made to inform you before each such field trip or other activity occurring away from the synagogue property.
In the event of emergency, I hereby empower the members of the Congregation Rodeph Sholom staff, and each of them, to act for me in accordance with his/her best judgment.

Family/Health Information

In case of emergency contact:

* Name

* Relation to Child

* Best Contact Phone Number

Doctor's Name

Doctor's Phone Number

Insurance Company

Policy Number

Please list all allergies, medical concerns, and dietary restrictions of child participating.

Please contact Maci Morse with any questions.
Youth@rsholom.org

Sat, April 20 2024 12 Nisan 5784