Shalom, New York City - Registration Form
Teen Trip to New York City
Trip Dates: August 16 - 17, 2026
By registering my child for the Teen Trip to New York, 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 teen Jewish?
Yes
No
Teen's First Name
Teen's Last Name
Teen's Legal Name as it appears on government issued identification or school identification (if different from above):
Teen's Cell
Teen's Email
Teen's Mailing Street
Teen's Mailing City
Teen's Mailing State/Province
Teen's Mailing Zip/Postal Code
Teen's Birthdate
Teen's Gender
Teen's Current Grade in School
Name of School
List of teen's allergies and treatments (if not applicable, write NA):
List of teen's current medications and dosage and when taken
(if not applicable, write NA)
:
Is teen under the care of a mental health professional? If yes, please explain
(if not applicable, write NA)
.
Explain any dietary requirements
(if not applicable, write NA)
:
Name and cell number of an individual who can be contacted in the event of an emergency if parents/guardian(s) cannot be reached:
I grant to Lappin Foundation, its representatives, and employees the right to take photographs of my child in connection with the Teen Trip to New York. 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
Parent/Guardian Information
First Name
Last Name
Email
Cell Phone
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip Code
Relationship to Teen
Please select...
Parent
Grandparent
Family
Other
Is there a second parent/guardian?
Yes
No
Second Parent/Guardian
First Name
Last Name
Email
Cell Phone
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip Code
Relationship to Teen
Please select...
Parent
Grandparent
Family
Other
Contact Information