Temple Beth Shalom Youth Programs
Name of Student
First Name
Last Name
Student Phone Number
Please enter a valid phone number.
Current Grade
Please Select
8th
9th
10th
11th
12th
Which program/s are you joining?
USY
TEXT
Confirmation Class (10th graders)
Teen Leadership (11th and 12th graders)
Name of Parent
First Name
Last Name
Parent Phone Number
Please enter a valid phone number.
Submit
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