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1st Semester 2023 - Kesher On The Go Excursion Permission Slip
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1ST SEMESTER 2023
KESHER ON THE GO
EXCURSIONS PERMISSION AND TRANSPORTATION FORM
NOVEMBER 8 | LOUIS MEMORIAL CHAPEL (BUS TRANSPORTATION PROVIDED)
6830 Troost, KC MO 64131
NOVEMBER 15 | GOLDEN SCOOP (STUDENTS MEET AT LOCATION)
9540 Nall Ave, Overland Park KS 66207
Questions? Email Dayna Gershon, education@bnaijehudah.org
Complete separate registration form for each child participating.
Participant Information
*
Participant First Name
Participant Preferred Name/Nickname
*
Participant Last Name
*
Preferred Pronouns
She/Her
He/Him
They/Them
Other
*
Participant Phone
*
Participant Email
November 8 | Louis Memorial Chapel
Please indicate if your participant will be riding the bus (to and from) Louis Memorial Chapel or if you are arranging your own transportation.
TRANSPORTATION TO: Louis Memorial Chapel - 6830 Troost Ave
Ride the bus, meet at B'nai Jehudah at 6:30 PM
Meet at Louis Memorial Chapel, arrive at 7:00
Unable to attend
TRANSPORTATION FROM: Louis Memorial Chapel - 6830 Troost Ave
Ride the bus back to B'nai Jehudah for pick up at 8:30 pm
Pick up at Louis Memorial Chapel at 8:00 pm
Unable to attend
November 15 | Golden Scoop
All participants will meet at the Golden Scoop.
*
November 15 | Golden Scoop - 9640 Nall Ave | 7-8:15
Please Select One
Attending
Unable to attend
Students meet at the Golden Scoop. Explore Sacred Community as we learn about the mission of Golden Scoop and enjoy some ice cream.
(No bus option available)
Parent/Guardian Information
*
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Parent/Guardian Phone
*
Parent/Guardian Email
*
Emergency Contact Full name
*
Emergency Contact Phone Number
Consent
Consent to ride the bus
Consent to ride the bus
The parent or legal guardian of the Participant named above, hereby consents for the Participant to take the bus to and from the indicated excursions that have been selected.
*
Consent to participate
Consent to participate
With respect to the child's participation in the program, the Parent/Guardian releases The Temple, Congregation B'nai Jehudah and its officers, agents, employees, and volunteers, harmless from any and all claims for personal injury to the above named student, including, without limitation, and claims based on negligence.
Code of Conduct Agreement
*
Conduct Agreement
Conduct Agreement
Participant agrees to participate in the programming and behave in a respectful and appropriate manner.
Sun, May 11 2025
13 Iyar 5785
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Sun, May 11 2025 13 Iyar 5785
