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Shakshuka Teens Lock-In

Friday, June 9, 2023 • 20 Sivan 5783

8:30 PM - 10:00 AM Next DayCBS

Shakshuka Teens, we're having a Lock-In at the synagogue after the Graduation Shabbat! Bring everything you need for an overnight when you come for the Graduation Shabbat, including a pillow and sleeping bag or blanket. We'll have dinner and a movie night, then a light breakfast before you leave on Saturday morning. Have questions? Ask our Shakshuka teen board (Ilenia, Noah Ewig, Noah Massey, or Luke), or email Leah! To attend, you must fill out the following form.

Register

The overnight will began immediately after our Graduation Shabbat services end on Friday June 9, and the overnight will end at 10 am on Sat. June 10.  All supplies for the overnight, ex. pillows, camping pads, etc., can be stored in one of the classrooms during the Shabbat service.

Student Information

Select student's grade in Fall of 2023 from the dropdown below.
If none, list "N/A"
Please indicate any dietary restrictions or preferences.

Medical Release

I/We, the undersigned, parent(s) of
, a minor, do hereby authorize Congregation Beth Shalom as agent for the undersigned to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable and is to be rendered under the general or specific supervision of a surgeon licensed under the provisions of the Medicine Practice Act. The authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until September 30, 2024.
Photos for Social Media and Promotional Purposes
We often take photos of the children during activities and events.  Do you give permission for photos of your child to be featured on Congregation Beth Shalom's social media or used for promotional purposes?

Parent Information

Parent #1

Parent #2

Emergency Contact

Please list an emergency contact if the parents cannot be reached.
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Wed, October 4 2023 19 Tishrei 5784