Teen Tzedakah Fund Membership Application

Name
Date of Birth
Address
City
State
Zip
Phone
E-Mail
Name of School
Grade
Temple Affiliation
Parents Information
Mother's Name
Address
City
State
Zip
Phone
E-Mail
Father's Name
Address
City
State
Zip
Phone
E-Mail
Grandparents Names
Emergency Contact
Name
Relationship
Home Phone #
Work Phone #

Teen Tzedakah Fund Membership Agreement

Statement of Purpose
Please provide us with a short, personal statement discussing your interest in the Teen Tzedakah Fund.  Tell us what you hope to bring to the group and what you hope to learn:

Membership Guidelines

• I agree to donate $180.00 to the Teen Tzedakah Fund.
• I agree to actively participate in all meetings, site visits and activities.
• I understand the importance of this unique opportunity to involve myself
  in my community and I will take this experience seriously.

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Our Sponsors

The Teen Tzedakah Fund
2640 North Forest Road, Suite 200 | Getzville, NY  14068
Telephone (716) 204-1133 | Toll-Free (877) 933-6369

Copyright 2008 The Teen Tzedakah Fund
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