YISE Youth Survey

YISE Youth Survey

Please fill out this form for each child in your family.

After you submit a form, there will be a link at the end to submit additional forms for each child.

This information will be used by the YISE Youth Committee, Youth Director and Youth Minyan coordinator to help us serve the growing needs of the youth at YISE.

This information will NOT be shared with other organizations.

If you have any questions about youth programs at YISE please contact bkugler@yise.org

* – Required fields

Child's First Name: *
Child's Last Name: *
Child's Email (if available):
Gender: *	Male Female
Interests – please select all that apply
Arts Activities
Community Service Activities
Jewish Learning Actvities
Shabbos Morning Groups – participant
Shabbos Morning Groups – leader
Social Activities
Sports Activities
Other:
Current Grade – 2016-2017: *	Select Grade…Nursery/PreschoolPre-KK123456789 – Freshman10 – Sophomore11 – Junior12 – SeniorOther
Current School: *	Select School…BermanJDSJPDSKemp Mill MontessoriLeo Bernstein Jewish AcademyLocal Public SchoolShomrai NurseryTorah SchoolYeshiva of Greater WashingtonOtherSilver Spring Learning Center
Current Age: *	Select Age…1234567891011121314151617
Birth Year:	Select Birth Year…2017201620152014201320122011201020092008200720062005200420032002200120001999
Parent(s) Name(s): *
Parent's Email: *
Address:
Phone:
Phone Type:	Home Cell (child) Cell (mother) Cell (father)
Comments/Feedback: If you have any specific ideas for improving the YISE Youth programming, please include them here.