B'nai Tzedek Participant Application

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Participant's Name *

Age *

Current Year in School *

Year of High School Graduation *

Parent/Guardian’s Name(s) *

Parent/Guardian’s Phone Number *

Address *

City *

Zip Code *

Teen's Email *

Parent/Guardian's Email *

Which email would you like to use to log in to the TOP Jewish Foundation portal? *

Teen's Email

Parent/Guardian's Email

How did you find out about the program? *

Are you a member of a local synagogue? If so, which?

I hereby grant to the Tampa JCCs and Federation and their legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs and/or motion picture/video film of my child, or in which they may be included, for editorial trade, advertising and any other purpose and in any manner and medium; and to alter the same without restriction. I hereby release the Tampa JCCs and Federation and their legal representatives and assigns from all claims and liability relating to said photographs, film, video recordings, videotapes, and all other visual mediums. *

Yes

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