Batya Chopped Competition

Participant's Name*

First NameLast Name

Is this the Participant's first JEP event of 2024/2025?*

Birthday*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number

Area CodePhone Number

Participant's Cell Phone Number

Area CodePhone Number

Participant's Email

Grade*

School*

Does the participant attend Hebrew School?*

Hebrew School*

Synagogue Affiliation*

Does the participant have any allergies?

Please list participant's allergies:*

Important Information/Special Concerns:

Mother's Name*

First NameLast Name

Mother's Email

Mother's Cell Phone Number

Area CodePhone Number

Is mother's home address the same as participant?

Mother's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Father's Name*

First NameLast Name

Father's Email

Father's Cell Phone Number

Area CodePhone Number

Is father's home address the same as participant?

Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parents' Marital Status*

Other:*

Does the participant have a stepparent?*

Stepparent via*

Stepparent's Name*

First NameLast Name

Stepparent's Email

Stepparent's Cell Phone Number

Area CodePhone Number

Second Stepparent via*

Second Stepparent's Name*

First NameLast Name

Second Stepparent's Email

Second Stepparent's Cell Phone Number

Area CodePhone Number

Please list participant's siblings and ages:*

Emergency Contact (if parents unreachable)*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship to Participant*

I hereby give consent for my daughter to participate in this JEP event. I understand that JEP takes photos and videos during events and posts them to the JEP website and social media and give permission for my daughter’s photos to be included in promotional materials. I understand that if my child has a medical need, JEP will make a conscientious effort to notify my spouse or me. In the event that this is not possible, I give permission for JEP Girls of Maryland and its staff, or person designated, to make available to my child professional emergency medical care when such care is indicated. I give permission for my child to receive proper medical care by any doctor, nurse, paramedic, or member of a medical staff of a hospital.*

By checking this box and printing my name below, I am giving my consent.

Parent's Name*

First NameLast Name

Email Address*

Date*

MonthDayYear

In addition to the Chopped Competition, we will be making Chanukah cards to show our appreciation to the children of IDF soldiers. Each card will include an ice cream gift card.

Would you like to donate $6 toward a gift card?*

How many gift cards would you like to donate?*

Hidden Total

Total*

USDDescription

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