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BarTY Membership Form
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2024-25 Membership Form
Parent/Custodian Info
*
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Temple Affiliation
Please select:
Barnert Temple Members
NOT Members of Barnert Temple
*
Where if anywhere are you a member? If not affiliated, enter N/A.
Teen Info
*
First Name
*
Last Name
*
Cell
*
Email
*
Name of High School
Grade of Teen
Please select:
8th grade
9th grade
10th grade
11th grade
12th grade
*
T-Shirt Size
*
I permit my child to participate in BarTY sponsored activities
I permit my child to participate in BarTY sponsored activities
Photos & Publicity
*
I permit my child’s photo to be displayed on the
private BarTY social media accounts
Please select:
Yes
No
*
I permit my child’s photo to be displayed on the
Barnert website and Barnert's public social media accounts
Please select:
Yes
No
Membership Fee
*
2024-25 BarTY Membership Fee
Please select:
Barnert Temple Member
Non Barnert Temple Member
Total Due
Sun, October 6 2024 4 Tishrei 5785