This registration form allows you to pay the entire registration fee of $400 or pay a deposit of $250. So that we can be fully prepared for the trip in advance, we will require the remaining balance of $150 by our trip departure date of January 30, 2026.
We absolutely do not want cost to be a barrier to your participation. Financial assistance can be discussed with Rachel Glazer .
STUDENT AND PARENT/GUARDIAN INFORMATION
TBE YOUTH TRIP WAIVER, INSURANCE AND MEDICAL INFORMATION
I give permission for my child/children to attend the Temple Beth El trip to Atlanta, GA, January 30 through February 1, 2026. I understand that personal injury can and may occur to my child, and I hereby authorize Temple Beth El staff, or another appointed youth advisor, to seek and consent to emergency medical attention for my child/children as needed; and I further agree to be liable for and to pay all costs incurred in connection with such medical attention. I hereby release Temple Beth El, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my child/children while participating in or traveling to and from this event. I agree to accept full responsibility, financially or otherwise, for any damage my child/children may do to any properties visited on our trip, other's personal property, or vehicles used for transportation. I agree and consent to all of the above stated.
* Please provide your child's health insurance information including name of policy holder, provider, group number and policy number:
* Please list any food allergies or dietary restrictions.For example, allergies to peanuts, tree-nuts, eggs, gluten-free, vegetarian, lactose intolerant. PLEASE LIST ALL ALLERGIES AND FOOD NEEDS. Please write NA if there are no allergies or food needs.
* Please list any medications your child will need to take during the trip:Write NA if your child will not need to take any medication during the trip.
* Please list any access needs we should be aware of.For example, mobility aids, hearing aids, gets overstimulated in crowds, needs frequent access to a bathroom, etc.
PAYMENT This registration form allows you to pay the entire registration fee of $400 or pay a deposit of $250. So that we can be fully prepared for the trip in advance, we will require the remaining balance of $150 by our trip departure date of January 30, 2026.
We absolutely do not want cost to be a barrier to your participation. Payment plans and financial assistance can be discussed with Rachel Glazer
$400 - Full Payment 0 1 2 3 4 5 6 7 8 9 10
$250 - Deposit (balance of $150 due by January 30) 0 1 2 3 4 5 6 7 8 9 10
TEMPLE BETH EL'S B'RIT KEHILLA - COMMUNITY COVENANT
Parents, please read this with your child/children attending the TBE trip:
I will strive to create an environment that is welcoming and comfortable for all participants. I will do my best to participate fully in all activities. I will be present, physically and mentally, throughout the event. I will show respect for my fellow participants and for all chaperones and group leaders. I will not possess, consume, or distribute alcoholic beverages. I will not possess, consume or distribute any illegal drugs or drug paraphernalia. I will not smoke, consume or distribute tobacco products. I will not participate in any inappropriate behavior. I will not participate in any activities that could be deemed as harassing, demeaning or hurtful. I agree to abide by any additional rules, pertinent to a specific event, which may be announced and to the consequences of their violation. I agree to follow any and all instructions given by the Rabbis, teachers and staff.
