NFTYx SAR/MAR Lock-In

Friday, May 17, 2024 • 9 Iyar 5784

All Day for 1 DaysTemple Beth El

LIBERTY and RALFTY are joining forces for a Jewish teen-powered overnight extravaganza!

The lock-in begins at 6:00pm on Friday, May 17 and ends at 2:30pm on Saturday, May 18, located at Temple Beth El (5101 Providence Road, Charlotte, NC 28226). See below for more information.

Teens should bring everything they need for an overnight, including a sleeping bag and pillow for sleeping in the social hall. Games and musical instruments are welcome! Please leave valuables at home.

Registration closes Tuesday, May 14. Questions? Contact Rachel Glazer, LIBERTY Advisor.

Register

LIBERTY & RALFTY LOCK-IN @ TEMPLE BETH EL, CHARLOTTE, NC
with support from NFTYx MAR and NFTYx SAR!

Friday, May 17th - Saturday, May 18th, 2024
ARRIVAL/DROP-OFF: Friday @ 6:00 PM
DEPARTURE/PICK-UP: Saturday @ 2:30 PM

Temple Beth El
5101 Providence Road
Charlotte, NC 28226

$36 for Overnight OR $20 for Saturday Only
Open to all Jewish teens in grades 8-12
Cost includes: Dinner, camp activities, breakfast, event merch, lunch, security, and more.

Late arrival/early dismissal is allowed with the approval/notification of Rachel Glazer, the LIBERTY Advisor. Please email her if you have questions.

*Teens that drive themselves to the event can NOT leave TBE property during the event without written notice from their parents. Teens are expected to stay the entirety of the event unless they have notified their advisor otherwise.

Questions? Contact Rachel Glazer.

Participant Information

* Participant First Name

* Participant Last Name

* Participant's Grade

* Participant's Date of Birth

* Participant's Cell Phone

Participant's Email

* Participant City

* Participant State

Is there anything else we should know about the participant's gender identity so we can best support them?

Does the participant have any access needs we should know about for this event?

Additional Participant Information

* Please list any food allergies or dietary restrictions.

* Does the participant carry an Epi Pen?

* Are there any special medical concerns (allergies, medications, etc.) should we know about?

* Will your participant carry any medications? Please list all and what they are used for.

(Ex: Inhaler, anxiety medication, allergy medication, glucometer, etc.)

* Does the participant have any behavioral/anxiety/social concerns you would like us to know about?

Parent/Guardian Information

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

* Parent 1 Cell Phone Number

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone Number

Emergency Contact Information
*We will always attempt to contact Parent 1 & 2 prior to the Emergency Contact. Please list someone other than Parent 1 or 2.

* Emergency Contact First Name

* Emergency Contact Last Name

* Emergency Contact Phone Number

* Emergency Contact Relationship to Participant

Congregation Affiliation Information

Is your family a member of a local congregation?

If you are affiliated with a Temple that was not listed, please list it here:

PERMISSION FOR EMERGENCY MEDICAL TREATMENT

* Name of Teen's Physician

* Physician Phone Number

* Insurance Carrier

* Insurance Policy Number

* Name of Insurance Policy Holder

I/we will indemnify, save harmless and defend Temple Beth El, its officers, directors, agents, and employees, from all liability from loss, damage, or injury to persons or property in any manner arising out of or incident to the performance of this agreement including without limitation all consequential damages and/or attorney's fees. in the event of a medical emergency and I/we cannot be reached, I/we hereby give permission to the physician selected by the Temple agent to hospitalize and secure proper treatment for my child(ren) as named herein.

* Parent/Guardian Signature

*Electronic Signature Required

Code of Conduct

The undersigned acknowledges that an online signature will, for all purposes, be treated as an original.

* Parent/Guardian Signature

By entering an electronic signature above, a parent or guardian on behalf of each Participant and all parties responsible for Participant, confirms that they have read and understood the NFTY B’rit Kehillah, and understand that if the Participant does not abide by the code of conduct in place, their parents will be contacted and the Participant will be dismissed from the event.

In the mutual interests of Temple Beth El, the Participant, and for the well-being of all participants at Temple Beth El, I understand, respect and will observe the rules, regulations and policies of Temple Beth El, which have been developed for the benefit of all participants, to strengthen the Temple Beth El program and enhance the experience for all participants. As parent/guardian of Participant, I agree to the implementation and enforcement of the following rules, regulations and policies for Temple Beth El programming.

Teen First & Last Name

Teen's Grade

Teen Cell Phone

Teen Email

Teen City

Teen State

Teen Pronouns

Is there anything else we should know about the participant's gender identity so we can best support them?

Does the participant have any access needs we should know about for this event?

Additional Participant Information

Please list any food allergies or dietary restrictions.

Does the participant carry an Epi Pen?

Are there any special medical concerns (allergies, medications, etc.) should we know about?

Will your participant carry any medications? Please list all and what they are used for.

(Ex: Inhaler, anxiety medication, allergy medication, glucometer, etc.)

Does the participant have any behavioral/anxiety/social concerns you would like us to know about?

PERMISSION FOR EMERGENCY MEDICAL TREATMENT

If this child's physician/insurance information is different, please provide it here.

Please provide any of the following information if it differs from your other child(ren): Name of child's physician, Physician's phone number, Insurance carrier, Insurance policy number, Name of insurance policy holder

If emergency contact info for this child is different, please provide it here.

Please provide any of the following information if it differs from your other child(ren): Emergency contact 1 name, relationship, & phone number; Emergency contact 2 name, relationship, & phone number

Parent/Guardian E-Signature

Date

If emergency contact info for this child is different, please provide it here.

How many teens are you registering for $36 each?

These teens are staying from Friday - Saturday.

How many teens are you registering for $20 each?

These teens have approval from Rachel to ONLY attend a portion of the event.

Total amount billed

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Tue, April 30 2024
22 Nisan 5784

Tue, April 30 2024 22 Nisan 5784