DELETE - 19-20 RS Retreat - Spend the day with us at Camp Alonim

Saturday, December 7, 2019
Camp Alonim in Simi Valley

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

Cost $75 day rate for kids / $100 day rate for adults

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

* Number of Children

* 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)