Shoresh Outdoor School Registration
Email address
Child Information
First Name
Your answer
Last Name
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Birthday
Your answer
Gender
Guardian Phone
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Address
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City
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Postal Code
Your answer
Guardian Information
Name
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Email
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Relationship
Your answer
Phone Number
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Emergency Information
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Emergency Contact Relationship
Your answer
Allergies
Your answer
Does your child use an epipen or inhaler?
Your answer
Does your child have any physical, mental or emotional issues we should know about?
Your answer
Other
Select the session(s) for which you would like to register:
What is your first language?
Your answer
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?
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
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