Teen Scene

Temple Isaiah Youth Group

* Family Name

* Family Address

TI MEMBER Annual Youth Group Fee

If you have more than 5 teens in your family, please reach out to us directly to pay: [email protected]

NON-MEMBER Annual Youth Group Fee

If you have more than 5 teens in your family, please reach out directly to submit payment: [email protected]

Teen 1

* Teen Name

* Teen Birthday

* Teen Email

Please type NA if they don't have an email

* Teen Phone

Please type NA if they don't have a phone

* Special Needs / Allergies / Notes

Please list any special needs, allergies, for this youth. Please type NA if none.

Teen 2

Teen Name

Teen Birthday

Teen Email

Teen Phone

Special Needs / Allergies / Notes

Please list any special needs, allergies, for this youth. Please type NA if none.

Teen 3

Teen Name

Teen Birthday

Teen Email

Teen Phone

Special Needs / Allergies / Notes

Please list any special needs, allergies, for this youth. Please type NA if none.

Teen 4

Teen Name

Teen Birthday

Teen Email

Teen Phone

Special Needs / Allergies / Notes

Please list any special needs, allergies, for this youth. Please type NA if none.

Teen 5

Teen Name

Teen Birthday

Teen Email

Teen Phone

Special Needs / Allergies / Notes

Please list any special needs, allergies, for this youth. Please type NA if none.

Parent / Guardian Information

* Parent / Guardian 1 Name

Parent / Guardian 1 Address (if different from above)

* Parent / Guardian 1 Phone

* Parent / Guardian 1 Email

Parent / Guardian 2 Name

Parent / Guardian 2 Address (if different from above)

Parent / Guardian 2 Phone

Parent / Guardian 2 Email

Emergency Contact Information

* Emergency Contact Name

* Emergency Contact Relationship

* Emergency Contact Phone

Permission and Signatures

* I give permission for my teen to participate in Teen Scene programming

Yes

* I understand that my child(ren) will be required to sign a code of conduct at the first meeting in order to participate in Teen Scene. Failure to abide by this code may result in removal from Teen Scene with no refunds.

Yes

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Comments

For added Security please check the box below.

Total:

Teen Scene

Teen 1

Teen 2

Teen 3

Teen 4

Teen 5

Parent / Guardian Information

Emergency Contact Information

Permission and Signatures

Account Details

Payment Information

Credit Card

Checking Account

For added Security please check the box below.