Consent to be filled out by parent participant* By checking this box, I acknowledge and represent that I am at least eighteen (18) years of age and that I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by agreeing to these terms, and agree to them freely and voluntarily without any inducement.
LIABILITY ACKNOWLEDGEMENT AND WAIVER
FOR PARENT/GUARDIAN ON BEHALF OF A PARTICIPANT OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)* By checking this box, I acknowledge and represent that I, as parent/guardian with legal responsibility for this participant, have read this release of liability and assumption of risk agreement, fully understand its terms, consent and agree to my minor child/guardianee’s release as provided, understand that I have given up substantial rights by agreeing to these terms, and agree to them freely and voluntarily without any inducement.
LIABILITY ACKNOWLEDGEMENT AND WAIVER
Media Release to be completed by parent.* By checking this box, I acknowledge and represent that I am at least eighteen (18) years of age and that I have read the THE ORTHODOX UNION MEDIA RELEASE, and that I understand it and sign it voluntarily.
ORTHODOX UNION MEDIA RELEASE
Media Release FOR PARENT/GUARDIAN ON BEHALF OF A PARTICIPANT OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)** By checking this box, I acknowledge and represent that I, as parent/guardian with legal responsibility for this participant, have read the Orthodox Union Media Release, fully understand its terms, consent and agree to my minor child/guardianee’s release as provided, understand that I have given up substantial rights by agreeing to these terms, and agree to them freely and voluntarily without any inducement.
ORTHODOX UNION MEDIA RELEASE
Parent Program Registration Parent Name*
First
Last
Legal Name of Parent (if Different)
First
Middle
Last
Parent Email
Parent Cell Phone
Parent Date of Birth
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Parent Nationalty
Parent Passport Number
Parent Passport Expiration
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Child Program Registration Child Name
First
Last
Legal Name of Child (if Different)
First
Middle
Last
Child Nationality
Child Passport Number
Child Email (If relevant)
Child Passport Expiration
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Child Date of Birth
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Child Cell Phone
Whom Should we contact in case of an emergency?
Emergency Contact Phone Number
Emergency Contact Email
Any food needs or allergies?
If you have already booked your flight, please input your flight information here.
Airline & Flight number.
. Time of arrival in Israel on Monday
Please list any important information you would like the trip organizers to know
How many children are coming with you? If you are bringing more than one child, please fill out the second child's information below.
Would you like us to arrange lodging for you? Rate is $190 per night for one room, Monday night through Wednesday night. (This is separate from our trip to the north - the hotel for Tuesday night is already included in the trip fee.)
Donation Amount
Coupon Total
$0.00
Billing Address
Second Child Information Child Name
First
Last
Legal Name of Child (if Different)
First
Middle
Last
Child Nationality
Child Passport Number
Child Passport Expiration
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Child Date of Birth
DD slash MM slash YYYY
Please note- this is in the Israeli format of Day, Month Year
Comments
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