Yachad West Coast Shabbaton {{ year }}

Thank you for your registering!
West Coast Family Shabbaton
November 9-11, 2018
DoubleTree Hotel, Anaheim, California

If you require a scholarship, please contact Monica Rukhman BEFORE filling out the application. LosAngelesYachad@ou.org or 310-229-9000 x206

PARENT/ GUARDIAN INFORMATION (ONLY THOSE ATTENDING)

Please List all Non Married Children Attending (Including Yachad Members):

Siblings are welcome and encouraged to attend.

OTHER RELATIVE INFORMATION (ONLY THOSE ATTENDING)

Please list children attending with "other relative":

ROOMING REGISTRATION

PLEASE FILL OUT ACCORDING TO HOW MANY ROOMS YOU WILL BE OCCUPYING

*Yachad will try its best to accommodate requests, but cannot guarantee them

Room {{ (index + 1) }}






(King Bed rooms only have ONE bed; Double Bed rooms have 2 full-size beds)

Names of people staying in the room:

(Yachad members 8+ have the option to room with parents or together with advisors/other members)

Please check if you will need the following **:






* There is an additional charge for cribs and refrigerators ($15 each per night)
** The hotel has a limited number of refrigerators and we need to make sure that those that absolutely need them receive them

CHILD / ADULT WITH DISABILITY (YACHAD MEMBER) INFORMATION



* Yachad members under the age of 8 must room with family





Medication


NAME:
(specific name of the medication)
TIME GIVEN:
Morning Afternoon Evening
DOSAGE:
(amount of)
DESCRIPTION:
(Size, Shape, Color)
PURPOSE:
(why medication is given)
Procedure to follow if medication is missed

Please check off all that applies to your child in order to help our staff work with him or her throughout the weekend:






LEARN ABOUT YACHAD

Do you want to be contacted by one of the Yachad departments to get more information about our programs? If yes, please choose the department you would like to be contacted by below.



SHABBATON PAYMENT

Application Details
Description Quantity Unit Price Total
Adults {{ balance.adults.qty }} ${{ balance.adults.price }} ${{ balance.adults.sub_total }}
Children 7-11 {{ balance.seven_to_eleven.qty }} ${{ balance.seven_to_eleven.price }} ${{ balance.seven_to_eleven.sub_total }}
Children 3-6 {{ balance.three_to_six.qty }} ${{ balance.three_to_six.price }} ${{ balance.three_to_six.sub_total }}
Children 0-3 {{ balance.zero_to_three.qty }} ${{ balance.zero_to_three.price }} ${{ balance.zero_to_three.sub_total }}
Refrigerator {{ balance.refrigerators.qty }} ${{ balance.refrigerators.price }} ${{ balance.refrigerators.sub_total }}
Cribs {{ balance.cribs.qty }} ${{ balance.cribs.price }} ${{ balance.cribs.sub_total }}
Total: ${{ balance.total }}
Scholarship Total:${{ balance.scholarship }}
Payment Option
Checks can be mailed into Yachad office:
Yachad West Coast Family Shabbaton
9831 W. Pico Blvd
Los Angeles, CA 90035
Attn: Monica Rukhman

* If you choose to pay by check, your application and reservation will NOT be processed until payment is received.

Payment Information