Legacy Adventure Retreats

APPLICATIONS

Required fields are in Bold.

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 Information:

When would you prefer to attend?

From	,
To	,

Which trip are you applying for?

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: (Please list two)
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: