Shoresh Outdoor School Registration
Email address *
Child Information
First Name *
Your answer
Last Name *
Your answer
Birthday *
Your answer
Gender *
Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Program Site and Program Fees
Shoresh Outdoor School Location *
Do you require a program fee subsidy? *
Our program fee is $160/student. Limited program fee subsidies available.
Do you have a discount code?
If yes, please enter it here.
Your answer
Guardian Information
Name *
Your answer
Relationship *
Your answer
Email *
Your answer
Phone Number *
Your answer
Emergency Contact Information
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship *
Your answer
Health and Wellness
Does your child have any allergies? *
If yes, please list here.
Your answer
Does your child use an epipen or inhaler? *
If yes, please provide more information here.
Your answer
Does your child have any physical, mental or emotional issues we should know about in order to best support them?
Your answer
Getting to Know You Better
What is your child's first language?
Your answer
Does your child attend (or has your child attended) Jewish day school? If yes, which one(s)?
Your answer
Are you affiliated with a synagogue? If yes, which one(s)?
Your answer
Does your child attend (or has your child attended) Jewish overnight camp? If yes, which one(s)?
Your answer
Does your child participate (or has your child participated) in any other Jewish program? If yes, which one(s)?
Your answer
How do you identify Jewishly?
Your answer
Have you been to a Shoresh program or the Kavanah Garden in the past?
Your answer
How did you hear about the Shoresh Outdoor School? *
Your answer
A copy of your responses will be emailed to the address you provided.
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