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kesty45 Registration 2017-2018

Enroll here to become a member of our 4th and 5th grade youth group!

Student Information

(example: science, dancing, human rights, nature, etc)

Guardian Information

Student Health Information

Please include all relevant allergies (seasonal, food, medicine, animals, etc) AS WELL AS reaction type (rash, anaphylaxis, sneezing)

(examples: current medications, asthma, easily stressed/anxious, frequent moments of sadness, lactose intolerant, bad joints from sports, etc)

(examples: advil, pepto bismol, cough drops, etc)

(any over the counter medications your child CAN NOT take)


I hereby give permission for my child to participate in any/all kesty45 activities for the 2017-2018 school year, including those that take place at the temple and off-site.

I hereby give permission for my child to be driven to and from Temple Emanuel by a staff member or parent volunteer when activities require going off-site.

I hereby acknowledge that a one-time, per-student addition of $36 will be applied to my Temple Emanuel account for kesty45 dues.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

I understand that the credit card payment amount is 2.5% higher; please include the 2.5% with my payment.

For added Security please check the box below.