Participant information form Jewish Teen trip to Boston, November 11, 2025

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Please see the trip description here and contact Melissa Herman with any questions.

Email *

Student name *

Student year in school *

Student cell phone number *

Student dietary restrictions and medical issues we should know about *

Student congregation *

Kol Ha'Emek Hanover NH

Jewish Community of Greater Stowe

Shir Shalom Woodstock

Ohavi Zedek Burlington

Temple Sinai S. Burlington

Rutland Jewish Center

Israel Congregation Manchester VT

Congregation Beth El Bennington

Brattleboro Area Jewish Community

Havurah of Addison County

Congregation Beth El St. Johnsbury

Beth Jacob Synagogue Montpelier

Bethlehem Hebrew Congregation NH

Other:

Parent 1 name *

Parent 1 phone *

Parent 1 email *

Parent 2 name

Parent 2 phone

Parent 2 email

During the trip we'll be taking photos which may be used on the synagogues' websites, social media platforms, and for grant reports. Please choose one of the following options:

* Media Release

Please Select One

Payment agreement

Please send checks to Kol Ha'Emek Boston trip, 5 Occom Ridge, Hanover NH 03755

I am sending a $100 deposit for my child and will pay the balance ($90) by October 17

I am sending a $100 deposit for my child, will pay the balance (TBD) by October 17, and will add some extra to help defray the costs of leaders.

I'd like to speak with someone about financial aid in order for my child to participate.

I'm not sure if my child will be able to participate on the trip--please contact me to discuss.

Other:

Send me a copy of my responses.

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