Kids Night In

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Family Name

Parent First Name

Parent Last Name

Phone Number (with text capability)

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

Number of Children - Temple Members ($10 Each)

Child First Name

Child Last Name

Age

Child First Name

Child Last Name

Age

Child First Name

Child Last Name

Age

Child First Name

Age

Number of Children - Non-Members ($15 Each)

Child First Name

Child Last Name

Age

Child First Name

Child Last Name

Age

Child First Name

Child Last Name

Age

Child First Name

Child Last Name

Age

Please read and check each box below indicating you are aware of our guidelines for the Kids Night In program.

* My child(ren) can use the toilet independently.

My child(ren) can use the toilet independently.

* I will remain at Temple Israel throughout the evening while my child is at Temple Israel.

I will remain at Temple Israel throughout the evening while my child is at Temple Israel.

* I understand that children are NOT permitted into the Adult Purim Spiel. Should my child need me, I will be notified by text message, or a Temple staff member will inform me.

I understand that children are NOT permitted into the Adult Purim Spiel. Should my child need me, I will be notified by text message, or a Temple staff member will inform me.

* I will pick up my child no later than 10pm.

I will pick up my child no later than 10pm.

Additional Information

Sat, October 25 2025
3 Cheshvan 5786

Sat, October 25 2025 3 Cheshvan 5786