TLC Registration

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Join us for exciting and innovative teen programming!

2021-2022 TLC Registration

Registration is not complete until we receive payment.

"*" indicates required fields

Family Contact Information

Teen(s) Address*

Street Address City State ZIP Code

Teen Home Phone

Parents

Parent 1 First Name*

Last Name*

Email*

Cell Phone*

Work Phone

Parent 2 First Name

Last Name

Cell Phone

Work Phone

Additional Guardianship Information

Is there anything else you would like us to know regarding your child's (or children's) living arrangement? All information will remain confidential.

Please include any other relevant mailing address.

Emergency Contact Information

Do NOT list parents/guardians listed above. Please list other emergency contacts.

First and Last Name*

Cell Phone*

Home Phone

Other Phone

Medical Consents

I agree that if my child should need any medical attention, Bet Torah is authorized to provide and arrange for treatment and I will be responsible for any costs associated with the treatment.*

I understand that Bet Torah will make every reasonable attempt to reach me or anyone listed above as my emergency contact before using this authorization.*

Vaccinations and Immunizations

All children I have registered above meet all New York State vaccination requirements to be admitted to public, private or parochial school for the 2021-22 school year.*

Yes

Covid vaccination policy will be communicated in the fall.

Is there anything you would like to add regarding immunizations?

General Consents

Photo Release*

I understand Bet Torah and its representatives might use photographs of my child in/on the synagogue newsletter, website, social media, including the internet and bulletin boards and in local media. Photos may also be shared with our partner organizations (including but not limited to Mount Kisco Interfaith Food Pantry, Moving Traditions, USY, J-Teen) for their use in similar media.

Yes

Other

Travel and Trips*

I grant permission for my child to participate in activities and trips (including but not limited to Midnight Run, trips to NYC, programs at private homes, programs at other congregations, etc.).

Yes

Other

I confirm that the above information if accurate, that the guidelines and procedures of Bet Torah will be adhered to and that I understand it is my responsibility to keep the above information current.*

Is there anything you would like to add regarding consents?

Tuition

Teen 1

Price: $0.00

We value your family’s involvement in Bet Torah and TLC. If you are experiencing financial difficulties or would like to make an alternative payment plan, Executive Director Seth Young will be able to assist you.

Teen 2

Price: $0.00

Teen 3

Price: $0.00

Total Due by Check

Price: $0.00

Please make your payment to "Bet Torah" and indicate "TLC Tuition 2021-2022" in the note section. Send to:
Bet Torah Synagogue
60 Smith Ave, Mt Kisco, NY 10549

Thank you for your prompt payment of tuition. Registration is not complete until we receive your check.

This field is for validation purposes and should be left unchanged.

Effective September 1, 2021, it is Bet Torah policy that everyone who is eligible to be vaccinated, be vaccinated, including the 12 and up age group, in order to enter the building or participate in any Bet Torah programming indoors.

COVID-19 Vaccination Form

Contact Us

Loen Amer, Director of Experiential Learning for Children and Teens
youth@bettorah.org
914-666-7595 x139

Want to chat? Book a meeting on Loen’s calendar.

Gina Fass, Director of Kulanu Learning Program
gfass@bettorah.org

2021-2022 TLC Registration

TLC Selection

Teen 2

TLC Selection - Teen 2

Teen 3

Teen 3 - Program Selection

Family Contact Information

Parents

Emergency Contact Information

Medical Consents

Vaccinations and Immunizations

General Consents

Tuition

Contact Us