Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Login
New User:
Register Now
Home
Village
Visitors
Services
Contact Us
About Us
Events
Donate
Home
Village
Visitors
Services
Contact Us
Cafe LoMPTY: Drive Thru the Decades
Please verify reCaptcha before submitting the form.
Thank you so much for joining us at Cafe LoMPTY! Register below to secure your spot at our
March 20
Drive Thru where you will receive tons of goodies, gifts, surprises and SWAG! Just stop by Congregation Or Ami
any time between 2:00 and 4:00 pm
Then later that same night at
7:00 pm
, we meet on Zoom for live performances. Zoom link will be in your confirmation email.
WANT TO PERFORM?
Please fill out
this form here
to let us know!
HELP US WITH OUR SOCIAL ACTION PROJECT
Bring with you snack donations for
Click Here
for more info on Goodies to Go
Questions?? Contact Teen Engagement Coordinator Andrew Fromer at
andrew@orami.org
*
Teen's First Name:
*
Teen's Last Name:
*
Email:
So we can send a confirmation email with the Zoom link.
*
Phone Number:
So we can text you a reminder and/or any last-minute updates.
*
Check this box to secure your spot for $10!
Check this box to secure your spot for $10!
Add Additional Teens Here:
*
Teen First Name:
*
Teen Last Name:
Email:
If different from above.
Phone Number:
If different from above.
Check this box to secure their spot for $10!
Check this box to secure their spot for $10!
Emergency / Liability Form
Please fill out the following information in case of emergency.
*
Teen's Doctor:
*
Doctor's Phone:
*
Medical Insurance Provider:
*
Name of Subscriber:
*
Insurance Policy Number:
Please list any medical conditions, allergies, etc. of teen(s):
*
Parent Full Name:
*
Parent Cell:
*
Parent Email:
*
Additional Emergency Contact - Full Name:
*
Emergency Contact Cell Phone:
*
I/we hereby give permission for my/our teen to participate in Congregation Or Ami's Youth Group Event, and agree to release and hold harmless Congregation Or Ami, its Rabbis, cantor, educators, staff, board members, leaders, and its representatives from all costs, damages, claims, causes of action, losses and liability arising out of or related to my/our teen’s participation in, or transportation to/from/during, this activity. Moreover, I/we hereby assume all risks inherent in or associated with my/our teen’s participation in, or transportation to/from/during, this activity. In the event of an emergency or the sudden illness of my/our teen occurring when I/we cannot be reached, I/we also give my/our consent for my/our above-named teen to be treated by such emergency medical personnel, doctors and/or hospitals, as are selected by Congregation Or Ami. I/we understand that in the event of such emergency, Congregation Or Ami will make reasonable efforts to consult with the physician or medical group named above, but the nature of the emergency may require treatment be undertaken before such consultation is possible. Congregation Or Ami does not accept responsibility of loss, damage to, or theft of the teen’s property. I HAVE READ AND FULLY AGREE TO THE TERMS ABOVE.
My typed name above serves as my signature.
*
Date:
Total:
Thu, March 28 2024
18 Adar II 5784
Join Our Mailing List
Thu, March 28 2024 18 Adar II 5784