7th Grade Escape Room 2024

7th Grade Escape Room Adventure!
Sunday, December 8th, 2024, 12:00-1:30pm
The Puzzle Parlour, 131 Court Street, White Plains NY 10601

Participant Information

* Participant First Name

* Participant Last Name

* Participant Email Address

Participant Cell Phone Number

* My child is allergic to... (if nothing, enter N/A)

* Additional Information (if nothing, enter N/A)

My child may be given the following over the counter medications (such as headache relief medication, cough drops, decongestants, etc.):

Parent/Guardian Information

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

* Parent/Guardian 1 Email Address

* Parent/ Guardian 1 Cell Phone Number

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

* Parent/Guardian 2 Email Address

* Parent/ Guardian 2 Cell Phone Number

Emergency Contact Information
Emergency Contact MUST be separate from Parent/Guardian

* Emergency Contact First Name

* Emergency Contract Last Name

* Emergency Contact Cell Phone Number

* Relationship to Child

Permissions

* I, the undersigned parent of the child listed above, hereby give consent and permission for my child to participate in the 7th grade trip , and I empower the Trip Staff or their agents to act for me in accordance with their best judgment in case of emergency. I understand that all expenses for health care and medical attention will by my responsibility.

I, the undersigned parent of the child listed above, hereby give consent and permission for my child to participate in the 7th grade trip , and I empower the Trip Staff or their agents to act for me in accordance with their best judgment in case of emergency. I understand that all expenses for health care and medical attention will by my responsibility.

* I realize that no environment is risk free and so I have instructed my child on the importance of abiding by the Community Synagogue of Rye Teen Trips-Code of Conduct.

I realize that no environment is risk free and so I have instructed my child on the importance of abiding by the Community Synagogue of Rye Teen Trips-Code of Conduct.

* I, the trip participant, will abide by the code of conduct presented by the trip leadership.

I, the trip participant, will abide by the code of conduct presented by the trip leadership.

Program Registration Fee - $40 covering escape room ticket and staffing. Financial aid is available upon request - contact mparness@comsynrye.org.

If you have any questions, please contact Maya Parness, Director of Youth Engagement, at mparness@comsynrye.org.

* # of teens you are registering @ $40 each - non-refundable after 11/30/24

Total

Wed, November 27 2024
26 Cheshvan 5785

Wed, November 27 2024 26 Cheshvan 5785

Community Synagogue of Rye • 200 Forest Avenue Rye, NY 10580 • (914) 967-6262 • info@comsynrye.org • www.comsynrye.org

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