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DELETE - 19-20 RS Family Retreat @ Camp Alonim

December 6 - 8, 2019
Camp Alonim in Simi Valley

Unplug, Unwind, Connect
All parents and children are welcome!

Contact Sarah Escobar, Director of the Religious School
[email protected]

Parent Information

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Cell Phone

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

Child Information

* Child 1 Name

* Child 1 Grade

Child 2 Name

Child 2 Grade

Child 3 Name

Child 3 Grade

Child 4 Name

Child 4 Grade

Children in 8th grade or older will be charged the Adult rate based on accommodation. Children under 4 years old are free.

Accomodations

Children (Grades 3-7) - Supervised Staff Cabin

Enter the number of children that are Grades 3- 7. Children will be supervised in staff cabins.

Children (3yrs - Grade 2) - Staying with parent(s)

Enter the number of children 4yrs old - Grade 2 that will be staying with their parents.

Deluxe Conference Center Room:
Housed in the Adult Conference Center, these rooms have private bathrooms. Linens and towels are included.

Number of Adults

Emergency Contact Information

* Emergency Contact 1 Name

* Emergency Contact 1 Relationship

* Emergency Contact 1 Phone

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone

Release and Waiver of Liability Agreement

Click here to view the RELEASE AND WAIVER OF LIABILITY AGREEMENT

Parent 1 Participant

* I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.

I AGREE

* Parent 1 Full Name

Parent 2 Participant (Please agree only if 2nd parent is attending)

I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.

I AGREE

Parent 2 Full Name

PARENT / GUARDIAN WAIVER FOR MINORS

* I hereby certify that I am the parent or guardian of the minor(s) named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual(s).

I AGREE

* Parent / Guardian Full Name:

* Relationship to Minor(s)

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase my donation by 3% to cover credit card fees. Please select YES to increase your donation.

Total:

DELETE - 19-20 RS Family Retreat @ Camp Alonim

Parent Information

Child Information

Accomodations

Emergency Contact Information

Release and Waiver of Liability Agreement

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

DELETE - 19-20 RS Family Retreat @ Camp Alonim

Parent Information

Child Information

Accomodations

Emergency Contact Information

Release and Waiver of Liability Agreement

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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