End Of Year Overnight - The Shul Bayside
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  Trip departs Sunday, May 28th at 8:00am & 
returns Monday, May 29th at 10:00pm 


To Reserve A Space:

It is essential that this entire application for is complete. 

 Registration form must be accompanied with payment of $125.00 which includes 
registration, activities, all meals, and transportation. 

No application will be processed without all required documents and signatures. 



Teen's Full First Name 

As Seen On ID
Teen's Full Last Name

As Seen On ID 

City, State, Zip
Cell Number
Teen's E-mail Address
Teen's Gender Male Female

Grade and School

Allergies D.O.B.
Father's Name Father's Cell
Father's E-Mail Mother's Name
Mother's Cell Mother's E-mail
  $125- For Teen Registration, Activities, Meals & Transportation.
  Please also add  as a scholarship for another teen who lacks funds.
Please confirm the total to be charged to your credit card:
Name on Card:  Card Number: 
Card Type:  Exp. Date:      

I give my son/daughter  permission to participate in the 
C-Teen Wisconsin End Of The Year Overnight.

Participants are expected to dress respectively and maintain proper decorum and attitude during the entire program. Disruptive behavior will not be tolerated in any way, shape or form.

Additionally, no participant may leave their group except at those times specified by the schedule.  

I understand that the Rabbis & chaperons reserve the right to enforce other rules relating to the integrity of the program and/or the health, safety or welfare of its participants.  

I certify that my child will conduct his/herself in a manner reflecting credit upon their Shul and the community. I have read these rules and understand them fully. 

By typing my name and the date below, I certify that the information on this application is true and correct and that I have read, and approve, the policies listed above.
 Signature:   Date: 


Problems with this form?  Please call (414) 228-8000 ext. 205 or e-mail misia@shulcenter.org

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