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2023-24 TESTIMONY THEATER CLEVELAND REGISTRATION FORM

2023-24 TESTIMONY THEATER CLEVELAND REGISTRATION FORM

Please complete the form below. Required fields marked with an asterisk *

2023-24 TESTIMONY THEATER CLEVELAND REGISTRATION FORM

STUDENT INFORMATION

First Name*

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Last Name*

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Date of Birth*

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Grade as of September 2023*

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Student Phone*

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Student Email*

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Student School*

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Jewish Experience (please check these that apply)*

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MJDS

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Fuchs Mizrachi

Synagogue School

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Bnei Akiva

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IsraelNow trip

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Synagogue *

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PARENTS INFORMATION

Parent 1 First Name*

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Parent 1 Last Name*

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Parent 2 First Name*

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Parent 2 Last Name*

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Parent 1 Phone*

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Parents 2 Phone*

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Parent 1 Email*

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Parents 2 Email*

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Address*

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City*

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State*

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Zip Code*

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In Case of Emergency, Person to Contact (If Not Parents)*

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PARENT OR GUARDIAN SIGNATURE

Parent or Guardian, Print Your Name and Date*

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Confirmation Email

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akiva for teens

26500 Shaker Boulevard, Cleveland Phone: (216) 367-1388 [email protected]

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@akiva For teens offers fun opportunities for cleveland teens to explore and strengthen their jewish identity and love for israel, while fostering everlasting friendships

From israel advocacy, leadership training and college prep for jewish students to original jewish theater, @akiva offers hebrew and so much more!

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