Shoresh Outdoor School Registration
Email address *
Child Information
First Name *
Your answer
Last Name *
Your answer
Birthday *
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Gender
Guardian Phone *
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Address
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City
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Postal Code *
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Guardian Information
Name *
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Email *
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Relationship *
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Phone Number *
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Emergency Information
Emergency Contact Name *
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Emergency Contact Phone *
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Emergency Contact Relationship *
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Allergies *
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Does your child use an epipen or inhaler? *
Your answer
Does your child have any physical, mental or emotional issues we should know about?
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Other
Select the session(s) for which you would like to register:
What is your first language?
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Does your child or has your child attended Jewish day school? If so, which?
Your answer
Are you affiliated with any synagogue? If so, which?
Your answer
Does your child or has your child attended Jewish overnight camp? If so, which?
Your answer
Has your child participated in any other Jewish program?
Your answer
How do you identify Jewishly?
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Have you been to a Shoresh program or the Kavanah Garden in the past?
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How did you hear about the Shoresh Outdoor School? *
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