Skip to Content

Menu Calendar

Calendar

About
Jewish Life
Education
Get Involved
Justice
- Social Justice Coalition
- Direct Action
Join
Donate & Pay

4-6th Grade Retreat

TIOH 4-6th Grade Retreat February 7-9, 2025

Child Name(Required)

First Last

Child Grade(Required)

4th Grade

5th Grade

6th Grade

Parent 1 Name(Required)

First Last

Parent 1 Cell Phone Number(Required)

Parent 1 Email(Required)

Parent 2 Name

First Last

Parent 2 Cell Phone Number

Parent 2 Email

Emergency Contact Name(Required)

First Last

Emergency Contact Relationship(Required)

Emergency Contact Phone Number(Required)

Sweatshirt Size(Required)

Child Large

Child XL

Adult Small

Adult Medium

Adult Large

Adult XL

Bunk/Cabin Requests

Please enter up to two participants you would like your child to house with

Is the participant covered by family medical/hospital insurance?(Required)

Yes

No

Insurance plan name/carrier(Required)

Insurance group number(Required)

Insurance policy number(Required)

Does the participant have any known allergies?(Required)

Yes

No

Please explain any known allergies here:(Required)

Dietary Restrictions

No red meat

No eggs

No fish

No poultry

No dairy

Other (please specify below)

Other dietary restrictions

If you selected other, or would like to include additional information regarding dietary restrictions, please explain:

Please explain any physical/social/emotional health issues your child may have:

Does your child have any sleep related issues? (e.g. sleep walking, bed wetting, trouble sleeping)

By checking "Yes" below, I am acknowledging that there is a non-refundable deposit of $100 as a part of my payment and that if I cancel less than two weeks before the event, Temple Israel is unable to refund any part of my payment.(Required)

Yes

Staff Code

Billing Information

Registration Fee

Amount:

Cover CC Fees

I wish to cover credit card fees for the temple by increasing my total by 3%

Credit Card Fees

$0.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

7300 Hollywood Boulevard, Los Angeles, California 90046 (323) 876‑8330

Open Sitemap +Close Sitemap -

About
Worship
Education
Community
Justice
- Social Justice Coalition
- Direct Action
Arts & Culture
- The Guiding Hand Yad Exhibit
Donate & Pay
Privacy Policy

Back to top

Notifications