February 22-23 - 4th and 5th Grade Shul-In - Form

Drop off: Saturday, February 22 at 5:00pm
Pick up: Sunday, February 23 at 9:00am or at 12:00pm after Yalla!
*If your child is not sleeping over please note in the form below and pick up your child at 9:00pm.
$25 per person

Come enjoy a night to remember at the Shul-In! This fun-filled overnight includes dinner, sweet treats, lots of games, GaGa, a movie on our big screen and all the fun your kids can handle! $25 covers programming, dinner, snacks, breakfast...and more snacks!

Please complete a separate registration form for each child participating.

Parent/Guardian Information

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Parent/Guardian Phone

* Parent/Guardian Email

Participant Information

* Participant First Name

Participant Preferred Name/Nickname

* Participant Last Name

* Preferred Pronouns

She/HerHe/HimThey/ThemOther

* Participant Phone

* Participant Email

* Congregation (if not B'nai Jehudah members)

Which grade level is your child in?

Grade 4Grade 5

Food Requirements

Gluten FreeDairy FreeVegetarianOther

"Other" food requirements? Please explain:

Does the participant have/need an inhaler, Epi-pen, insulin, seizure medication, or other emergency medication?

List all medications and instructions.

Does the participant have medication(s) that will need to be taken during the overnight?

List all medications and times to be taken and hand them to Rabbi Brazner when you drop off the participant.

* My child will be sleeping over and attending Yalla! in the morning.

Please Select OneYesNo, I will pick them up Saturday night at 9:00pm

Emergency Contact Information

(Be sure that the emergency contact person listed will be available if needed during this event on February 22 and 23)

* Emergency Contact Full name

* Emergency Contact Phone Number

Code of Conduct Agreement

* Conduct Agreement

Conduct AgreementParticipant agrees to participate in the programming and behave in a respectful and appropriate manner.

Registration Fees

* Registration Fees

Please Select One4th and 5th grade Shul-In participant - $25

Total Amount Due

REFUND POLICY: If a minimum of 10 participants do not register, a full refund will be given. A partial refund may be given if the Participant cancels their registration within 3 days prior to the event.