Legacy Adventure Retreats

APPLICATIONS

Required fields are in Bold.

Trip Information:
Please specify the trip you are attending:

Personal Information:

Full Name:

Date of Birth:

Gender:

Male Female

Address:

City, State, Zip:

, ,

Phone Number:

Home Address:
(if different)

Home City, State, Zip:
(if different)

, ,

E-mail Address:

Emergency Phone Contact:

Name

Number

How did you hear about us?

Educational Background:
Are you currently in school?	Yes No
If yes, please name school:
Major:
Were both parents born Jewish?	Yes No
If not, please explain:
Briefly describe your Jewish education:
How would you describe your Hebrew skill level?	Beginner Intermediate Advance

Attendance Details:
Do you have any special medical needs?	Yes No
If yes, please explain:
Have you ever attended a Jewish peer trip?	Yes No
If yes, please list:

Personal References (e.g. Rabbi, Teacher, or Mentor): (Please list two. Do not include family or friends.)
Name:
Address:
City, State, Zip:	, ,
Phone:

In one to two paragraphs please explain what role you would like Judaism to play in your life and why you would like to join this trip: