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5784 8th Grade Trip to LA
Please verify reCaptcha before submitting the form.
October 12 (evening) - October 15, 2023
Parent/Guardian Information
*
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Parent/Guardian Cell Phone Number (xxx) xxx-xxxx
2nd Parent/Guardian First Name
2nd Parent/Guardian Last Name
2nd Parent/Guardian Cell Phone Number (xxx) xxx-xxxx
*
Parent/Guardian Email- This email address will be used to send a confirmation email.
2nd Parent/Guardian Email
Please list the email address of any additional adults who should receive updates regarding this trip.
Teen Demographic Information
*
Teen First Name - as listed on federal identification documents.
*
Teen Middle Name - as listed on federal identification documents.
If not applicable, please write: NONE.
*
Teen Last Name - as listed on federal identification documents.
*
Teen Sex as Listed on Federal Identification Documents
*
Teen Birthdate
Teen's Preferred Name - if different from the legal name listed above.
This will be used for nametags and event purposes.
*
Teen's Pronouns
These will be used for nametags and event purposes.
*
Teen Cell Phone (xxx) xxx-xxxx
It is important that we have the teen's cell phone number for communication leading up to, and during, the trip.
*
Teen Email
It is important to have the teen's email for communication leading up to, and during, the trip.
Teen Medical, Social and Emotional Information
*
Please list all food allergies and dietary restrictions. For food allergies, please note the severity.
If your teen does not have any food allergies or dietary restrictions, please write: None.
*
Please list all non-food allergies and note the severity.
If your teen does not have any non-food allergies please write: None.
*
Please share any medical conditions or concerns. Please include any learning, social, emotional and behavioral needs.
This information will be kept confidential. It is necessary to ensure your teen's safety and enjoyment. If your teen does not have any, please write: None.
*
Please list any medications and relevant instructions for prescribed medications that will be taken while on this trip (please include epi-pens if your child carries one).
If your teen does not take any medication, please write: None
Please share any additional information about your teen that you would like us to know.
Please note any friends with whom your teen would like to room. While we cannot guarantee this request, we will do our very best.
*
Please upload an image of the front of your teen's health insurance card.
*
Please upload an image of the back of your teen's health insurance card.
*
Would you like to register a second teen?
Please select one
No, I would not like to register a 2nd teen
Yes, I would like to register a 2nd teen
2nd Teen Demographic Information
*
Teen First Name - as listed on federal identification documents.
*
Teen Middle Name - as listed on federal identification documents.
If not applicable, please write: NONE.
*
Teen Last Name - as listed on federal identification documents.
*
Teen Sex as Listed on Federal Identification Documents
*
Teen Birthdate
Teen's Preferred Name - if different from the legal name listed above.
This will be used for nametags and event purposes.
Teen's Pronouns
These will be used for nametags and event purposes.
*
Teen Cell Phone (xxx) xxx-xxxx
It is important that we have the teen's cell phone number for communication leading up to, and during, the trip.
*
Teen Email
It is important to have the teen's email for communication leading up to, and during, the trip.
2nd Teen Medical, Social and Emotional Information
*
Please list all food allergies and dietary restrictions. For food allergies, please note the severity.
If your teen does not have any food allergies or dietary restrictions, please write: None.
*
Please list all non-food allergies and note the severity.
If your teen does not have any non-food allergies please write: None.
*
Please share any medical conditions or concerns. Please include any learning, social, emotional and behavioral needs.
This information will be kept confidential. It is necessary to ensure your teen's safety and enjoyment. If your teen does not have any, please write: None.
*
Please list any medications and relevant instructions for prescribed medications that will be taken while on this trip (please include epi-pens if your child carries one).
If your teen does not take any medication, please write: None
Please share any additional information about your teen that you would like us to know.
Please note any friends with whom your teen would like to room. While we cannot guarantee this request, we will do our very best.
*
Please upload an image of the front of your teen's health insurance card.
*
Please upload an image of the back of your teen's health insurance card.
Event Cost
The cost for the LA trip is $1,000 per person, not including airfare. The cost DOES include all meals & snacks, hotel lodging, local transportation and program fares/admission fees.
Beth Am will make group airline reservations the day that the trip registration closes. We will send a follow up email with the cost of the airfare, which will be charged to your ShulCloud account. Based on previous years, we anticipate that airfare will cost approximately $250 per person.
As always, we do not want finances to be a barrier to participation for any of our teens. Financial assistance is always available.
Financial Aid Form
Cancellation Policy
Cancellations made prior to September 6, 2023, will be refunded in full.
Cancellations made between September 7 and September 29 will receive a 50% refund of the total cost including airfare.
Cancellations made between September 30 and October 12 will
not
be eligible for a refund.
Exemptions for extenuating circumstance may be available.
*
How many teens are you registering at this time?
Please Select One
One Teen
Two Teens
More detailed information will be shared with trip participants and their families as we get closer to the trip date. This will include the trip itinerary, packing list, and all trip logistics.
If you have any questions in the meantime, please don't hesitate to email
Lauren_Bohne@betham.org
or call/text her at (917) 750-1655.
Sun, December 10 2023 27 Kislev 5784
We strive to live as a holy community whose study and practice of Judaism inspires and challenges us to "do justice, to love kindness and to walk humbly with our God" (Micah 6:8).