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Masa Class Enrollment Form

STUDENT INFORMATION

PARENT 1 INFORMATION
PARENT 2 INFORMATION

Medical Information
**In addition to filling out information below, please submit a copy of your insurance card to Nancy Gorod, Director of Congregational Learning (ngorod@shearithisrael.com/404.503.9906).

ADDITIONAL INFORMATION

Enrollment Fees
**Trip to Washington will have additional fees**

PHOTO RELEASE

CSI has a Youth group website and a Facebook page where photos and videos from Youth group events are periodically published. We also have a Youth group bulletin board where we sometimes post photos from events. It is CSI's policy that photos of children are never published with names or other identifying information. Please initial one:
Sat, January 19 2019 13 Shevat 5779