Purim Prep Lounge Night March 4th 2025 - Form

See you on Tuesday, March 4th from 6:30-8:00 pm!
Eat pizza and then earn an hour of community service helping prepare for the Purim Carnival.

* Teen Last Name

* Teen First Name

* Teen's school:

* Teen Cell Phone Number

Teen Email (that you use most often)

* I am attending the Lounge Night on Tuesday, March 4th!

Share anything else we should know here.

allergies, any needs you have, etc.

* Adult Name

* Adult Email Address

* Emergency Contact Name

* Emergency Contact Phone #:

* I hereby state my permission for the staff of Beth El Synagogue Center Religious School of New Rochelle to take my teen to the Emergency Room in the event that I cannot be reached at any given number. All necessary treatment may be given at that time

I hereby state my permission for the staff of Beth El Synagogue Center Religious School of New Rochelle to take my teen to the Emergency Room in the event that I cannot be reached at any given number. All necessary treatment may be given at that time

* Does Beth El Synagogue Center have permission to photograph your teen(s) and use these photographs for marketing purposes, including but not limited to, insertion on the webpage?

Please Select OneYesNo