Yavneh Moshava Shabbaton Registration
Please complete the registration for each child and then calculate the payment amounts. You can make your payments for each child individually, or pay for more than one at a time

Friday night: 6th-8th Grade
Shabbos Lunch and programming 4th-8th grade
Cost:
Friday night: $25 per child
Shabbos Day: $25 per child

If attending both: $45 per child

Fill out the form below for each child and then pay here and note in memo line "For Yavneh Shabbaton"   

If you child is in high school and would like to volunteer to staff the events please contact Ari Hoffman

Sign in to Google to save your progress. Learn more
Parent Name(s) *
Mother's Cell *
Father's Cell *
Mother's Email *
Father's Email *
Child's name *
Child's Grade *
Events attending *
Required
Child's Doctor *
Child's Doctor's Phone #: *
Medical Insurance Carrier *
Medical Insurance #: *
Allergies *
Medications
Other health concerns *
 I give permission for my child(ren)’s counselors to administer emergency first aid to my child(ren) if needed, and to seek the assistance of medical professionals if the situation requires.  I understand that Camp Yavneh will make every effort to contact me immediately if emergency first aid is administered.  I understand that my child(ren) may not attend Camp Yavneh unless I give permission for emergency medical treatment. *
Required
I acknowledge that I am signing up my child(ren) for the Yavneh Shabbaton, which is a service provided by BCMH. I further acknowledge that the program incorporates some vigorous physical activity and interaction with other children, and that such activities by their nature carry inherent risk of injury.  I hereby certify that my child(ren) are fit, physically and otherwise, to participate fully in all activities. In consideration of my being allowed to place my child(ren) in high holiday daycare and intending to be legally bound, I hereby waive, release, hold harmless, covenant not-to-sue, and forever discharge any and all rights, actions or claims of negligence that I or my heirs, executors or assigns may have against Bikur Cholim – Machzikay Hadath, its officers, employees, agents, and leaders, for death, injury, loss and any and all damages that I or my child(ren) may sustain and/or suffer in connection with my child(ren)’s participation in the Yavneh Shabbaton.  I also agree to indemnify BCMH for any defense, cost, or expense arising out of any claim of damages, injury, or death arising from my child(ren)’s participation in the Yavneh Shabbaton. *
Additional emergency contacts if different from mother and father
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms