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Home
Ron Segev: An Evening Focused on Mental Health
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First Name
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Last Name
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Phone Number
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Are you a member of MJC?
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Are you a member of another synagogue?
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If you are a member of another synagogue, which one is it?
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Please list the names of adults attending
Number of Children (16 years and older)
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Please list names and ages of children attending
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I understand that sensitive material will be discussed and feel it will be appropriate for my child(ren) to hear.
I understand that sensitive material will be discussed and feel it will be appropriate for my child(ren) to hear.
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I understand that photos and/or videos may be taken by MJC at this event that may be used for promotional purposes in emails, on social media, and in print. I hereby grant permission for such use, and I hereby release the Merrick Jewish Centre, and its officers and directors, from any claims and liability that may arise from use of said photographs and/or videos. If I decide to not allow photos or videos of me or my child(ren) to be used I understand that I need to contact MJC at comms@mjc.org within 24 hours of the event ending.
I understand that photos and/or videos may be taken by MJC at this event that may be used for promotional purposes in emails, on social media, and in print. I hereby grant permission for such use, and I hereby release the Merrick Jewish Centre, and its officers and directors, from any claims and liability that may arise from use of said photographs and/or videos. If I decide to not allow photos or videos of me or my child(ren) to be used I understand that I need to contact MJC at comms@mjc.org within 24 hours of the event ending.
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By checking here, I agree to abide by all security measures put in place by MJC for the day of this program.
By checking here, I agree to abide by all security measures put in place by MJC for the day of this program.
Wed, April 30 2025 2 Iyyar 5785
