Please fill out this form to register your teen(s) for Teen Group. You can enter all teens (8th-12th grade) on the same form. Teen Group will begin on Sunday, September 7th, 2025. The base cost for the 2025-26 school year is:

$1650 for non-TBI members
$950 for active TBI members (login to your account to access member pricing!)

These amounts will be prorated for the time remaining in the school year.

Once you have finished entering all information, click the "Enroll" button to go to the payment page.

For any questions, reach out to Rabbi Ye'ela Rosenfeld here.

TBI Members: Please Log In to Register at the Member Rate ($750 Discount/Teen)!

Family Information

Parent 1:

Title

* First name

* Last name

Suffix

Hebrew name

(If available, English or Hebrew characters acceptable)

Father's Hebrew name

(If available, English or Hebrew characters acceptable)

Mother's Hebrew name

(If available, English or Hebrew characters acceptable)

* Email

* Mobile phone

* Home address line 1

Home phone

Home address line 2

* Home address city

* Home address state

* Home address zip

Work company name

Work position

Work phone

Work address

Work city

Work state

Work zip

Parent 2:

Add parent 2 to family account?

Add parent 2 to family accountDo not add parent 2 to family account: contact info only

Title

First name

Last name

Suffix

Title

First name

Last name

Suffix

Hebrew name

(If available, English or Hebrew characters acceptable)

Father's Hebrew name

(If available, English or Hebrew characters acceptable)

Mother's Hebrew name

(If available, English or Hebrew characters acceptable)

Mobile phone

Work phone

Mobile phone

Work phone

Home address line 1

(If different from parent 1)

Home phone

(If different from parent 1)

Home address line 2

(If different from parent 1)

Work company name

Work position

Work phone

Home address city

(If different from parent 1)

Home address state

(If different from parent 1)

Home address zip

(If different from parent 1)

Work company name

Work position

Work phone

Work address

Work city

Work state

Work zip

School and Medical Information:

Name and address of school

(If all children attend the same school)

Phone number of school

Name and address of family physician

If any child has a different physician, please enter their information in that child's section below.

Phone number of physician

Name and address of dentist

Phone number of dentist

If injury/illness is minor, do you authorize Temple Beth Israel Highland Park to administer first aid?

YesNo

If injury/illness is serious & you can’t be reached, do you wish your personal physician or dentist to be contacted?

YesNo

Insurance carrier

If any child has a different insurance plan, please enter their information in that child's section below.

Policy number

Permission to use your children's photos (website, newspaper, bulletin or T.V.)

YesNo

Permission to publish phone number on class roster

YesNo

Emergency Contact:

If you cannot be reached in case of an emergency, give the names of the people to be notified and/or to whom the child/children can be released..

* Name (Emergency Contact 1)

(Emergency Contact 1)

* Phone

(Emergency Contact 1)

Address

(Emergency Contact 1)

* Name (Emergency Contact 2)

(Emergency Contact 2)

* Phone

(Emergency Contact 2)

Address

(Emergency Contact 2)

Children:

* How many teens are you registering for Teen Group (non-TBI member)?

Are you an active TBI member? Login to your account and return to this form to access your $700 discount per teen!

New student?

* First Name

Middle Name

* Last Name

Suffix

Preferred pronouns

Hebrew Name

(If available, English or Hebrew characters acceptable)

* Birthday

* Grade

Please send us additional information information about TBI's B Mitzvah program

Does this child attend the school listed above?

YesNo

Name and address of school

Phone number of school

Does this child use the family physician listed above?

YesNo

Name and address of physician

Phone number of physician

Does this child use the family dentist listed above?

YesNo

Name and address of dentist

Phone number of dentist

* Does the child have any allergies? If so, please describe them. What should the school do in case of accidental exposure?

* Please explain any medical conditions of which the school needs to be aware:

Is this child on the insurance policy listed above?

YesNo

Insurance carrier

Policy number

Is there anything else the school should know about this child?

* Photography Permission

Temple Beth Israel has a website and participates in other social media. We produce various handbooks, brochures, advertisements, and DVD/videos in which we include pictures of our students, faculty, and staff. If you do NOT want pictures/images/video of your child(ren) to be included in TBILA materials and publications please indicate "Opt Out."

* I hereby grant permission to the Silverlake Independent JCC and Temple Beth Israel Highland Park to call a physician/dentist for necessary medical care or hospitalization for my child(ren) in case of an emergency, after trying to notify me first. Further, I release Temple Beth Israel Highland Park; it’s officers, agents and employees, from any and all liability.

I hereby grant permission to the Silverlake Independent JCC and Temple Beth Israel Highland Park to call a physician/dentist for necessary medical care or hospitalization for my child(ren) in case of an emergency, after trying to notify me first. Further, I release Temple Beth Israel Highland Park; it’s officers, agents and employees, from any and all liability.

* My teen agrees to help make the NELA Teen Group a safe and welcoming space for everyone.

My teen agrees to help make the NELA Teen Group a safe and welcoming space for everyone.

I am interested in receiving information about educational programming for adults at TBI.

TOTAL AMOUNT:

Total payment

(On the next screen, there will be options to pay immediately, set up monthly payments, or to bill to your account and pay by check. We also have an option to make alternative financial arrangements.)

NELA Teen Group

Upcoming Sessions

1. Sunday, March 22, 2026 • 4 Nisan 5786

2. Sunday, April 12, 2026 • 25 Nisan 5786

3. Sunday, April 26, 2026 • 9 Iyyar 5786

4. Sunday, May 3, 2026 • 16 Iyyar 5786

5. Sunday, May 17, 2026 • 1 Sivan 5786

6. Sunday, May 31, 2026 • 15 Sivan 5786

Register

TBI Members: Please Log In to Register at the Member Rate ($750 Discount/Teen)!

Family Information

Parent 1:

Parent 2:

School and Medical Information:

Emergency Contact:

Children:

TOTAL AMOUNT:

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