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Yachad Teen Aide Registration

Family Information
Parent #1 - Name*
Parent #2 - Name
Parent #1 - Cell Phone*
Parent #2 - Cell Phone
Parent #1 - Email*
Parent #2 - Email
Home Address*
Street Address Address Line 2 City State ZIP Code
Parent #2 Address is the same as Parent #1
- Yes
- No
Teen #1 Information
Teen 1 Full Name*
First Last
Teen #1 - Grade Level*
Teen #1 - Additional Options
- Sunday - Student Aide
Teen #2 Information
Teen #2 - Full Name
First Last
Teen #2 - Grade Level
Child #2 - Additional Options
- Sunday - Student Aide
Payment Information
Congregational Affiliation*
- Columbia Jewish Congregation
- Kol Nefesh

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