TeensLead Fall 2025 Application
By registering my child for TeensLead, I waive all liability of Lappin Foundation and the hosts/program partners of the program my child attends and all other participants for any injury suffered by my child or my family. (Please note that this question needs to be answered "YES" to participate in the program)
Yes
No
Teen Information
This program is for Jewish teens. Is your teen Jewish?
Yes
No
Teen's First Name
Teen's
Last Name
Teen's
Birthdate
Teen's
Grade as of September 1, 2025
Teen's
Cell Phone
Teen's
Personal Email
Teen's
Mailing Street
Teen's
Mailing City
Teen's
Mailing State/Province
Teen's
Mailing Zip/Postal Code
Name of High School Teen Attends
Does your teen have any allergies?
Yes
No
If yes, please describe and include treatment.
How did you hear about TeensLead?
Other - Please specify
Parent/Guardian Information
Parent's/Guardian's First Name
Parent's/Guardian's
Last Name
Parent's/Guardian's
Email
Parent's/Guardian's
Cell Phone
Parent's/Guardian's
Mailing Street
Parent's/Guardian's
Mailing City
Parent's/Guardian's
Mailing State/Province
Parent's/Guardian's
Mailing Zip Code
Parent's/Guardian's
Relationship to Teen
Please select...
Parent
Guardian
Grandparent
Family
Other
If other, please explain.
Add a second Parent/Guardian if applicable:
Yes
No
Second Parent/Guardian
Parent's/Guardian's
First Name
Parent's/Guardian's
Last Name
Parent's/Guardian's
Email
Parent's/Guardian's
Cell Phone
Parent's/Guardian's
Mailing Street
Parent's/Guardian's
Mailing City
Parent's/Guardian's
Mailing State/Province
Parent's/Guardian's
Mailing Zip Code
Parent's/Guardian's
Relationship to Teen
Please select...
Parent
Guardian
Grandparent
Family
Other
If other, please explain.
I grant to Lappin Foundation, its representatives, and employees the right to take photographs of my child in connection with TeensLead. I authorize Lappin Foundation its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that Lappin Foundation may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I waive any right to royalties or other compensation arising from or related to the use of the photographs taken of my child.
Yes
No
Contact Information