Israel Trip Form

Houston Teen Israel Experience Registration Form
Teen Full Name*

First NameLast Name
Teen Email*
example@example.com
Teen Phone Number*

Area CodePhone Number
Birthdate*
MM/DD/YYYY
School*
Grade as of fall 2024*

10th Grade11th Grade
T-Shirt Size*

SmallMediumLargeX-LargeOther
Synagogue Affiliation*

YesNoOther
If yes, with which synagogue is your family affiliated
Please list and describe all Jewish educational experiences you are currently involved in:*
Have you been to Israel before?*

YesNo
Using the space below, please respond to the questions completely. The questions are intended to help us learn about you and make sure that we are creating a high-quality experience for our community.
How would you describe your current relationship with Israel? How will participating in this experience influence the role of Israel in your life? *
What are three questions you have that you hope will be answered from this Israel experience?*
What are three things you hope to learn?*
Parent/Guardian 1 Full Name*

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number*

Area CodePhone Number
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Required Forms*

I acknowledge that there will be additional liability waivers and other documentation that I will need to complete in order for my child to participate in the Israel Trip
Date

MonthDayYear
Date
Payment Information

Registration is considered complete upon receipt of registration forms and complete payment. Payments can be made at by clicking here.
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Houston Teen Israel Experience Registration Form