Teen Advisory Board Registration Form

By registering for the Teen Advisory Board, I waive all liability of Lappin Foundation and the hosts/program partners of the program and all other participants for any injury suffered by me or my family. (Please note that this question needs to be answered "YES" to participate in the program)

YesNo

Information

This program is for Jewish teens. Are you Jewish?

YesNo

First Name

Last Name

Birthdate

Grade as of September 1, 2026

Cell Phone

Personal Email

Mailing Street

Mailing City

Mailing State/Province

Mailing Zip/Postal Code

Name of High School

How did you hear about the Teen Advisory Board?

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

If other, please explain.

Add a second Parent/Guardian if applicable:

YesNo

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

If other, please explain.

I grant to Lappin Foundation, its representatives, and employees the right to take photographs of me in connection with the Teen Advisory Board. 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 me 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 me.

YesNo

Contact Information