Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Log in
Log in
Home
Calendar
Event Promotion Request Form
Current Registration Forms
Wake Up Torah Study 2025-26
Donate
7th Grade Escape Room 2024
Please verify reCaptcha before submitting the form.
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
0
1
2
3
4
5
6
7
8
9
10
Total
Wed, July 2 2025
6 Tammuz 5785
Wed, July 2 2025 6 Tammuz 5785
