Teen Trivia Lounge Night: January 28, 2025 - Form

Beth El Teen Trivia Lounge Night. Tuesday, January 28th from 6:30-8 pm.

See you on Tuesday, January 28th from 6:30-8 pm!
Come eat pizza, do trivia, and hang out with friends
Feel free to bring your your homework.

* 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, January 28th!

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