Keshet Adult Spring Trip 2023 Sign Up

Adult Spring Trip 2023

Pack your bags, we're going to Disney!
Trip Details

Dates: Monday, April 24-Friday, April 28, 2023

Price: Single Room: $4,125 Double Room: $3,825, price includes everything needed for the trip (transportation to/from airport, flights, room, Kosher meals & snacks, and travel insurance).

All participants will be contacted to review eligibility and approve participation on the trip. Once approved, a 50% deposit is due at the time of registration (Single Room is $2,063 & Double Room is $1,913). Families will be contacted by Keshet billing regarding deposits and payments. Complete payment must be in by Wednesday, March 1, 2023.

Ages: 22+

Location: Disney’s Pop Century Resort

Packing list and additional details to follow.

MY Life Families: contact your house manager to complete registration.

Any questions please contact Polly Cheeseman pcheeseman@keshet.org 630-566-9391. Any billing questions please contact Anca Beniuc anca@keshet.org
Participant Demographic Information
Full Legal Name (first, last and middle if applicable)*
Date of Birth*
Gender*
Please upload your current form of photo identification for traveling. Acceptable documents can include State ID, Driver's License, or Passport.*

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Participant Medical Information

We will be holding on to all medications, vitamins, topicals and other related products for participants.
Do they currently take medications (RX, PRN, OTC) or vitamins?*
Please list medications/vitamins with their times and dosages and any specific instructions.*
Any dietary restrictions or allergies?*
Please list restrictions or allergies.
Does participant have a history of seizure?*
Please upload the most recent seizure plan.

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Does the participant have any other medical related products or needs that our nurse should know?

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Trip Information
Is participant registering for single or double occupancy room?*
Who is participant roommate request? (Please leave blank if no requests)
In addition to Magic Kingdom and Hollywood Studios, we would like to know which park the participant would want to visit. *
Parent/Guardian/Primary Point of Contact Information

Use space below to tell us more about participants parent/guardian or primary point of contact who is assisting in completing this registration.
Full Name*

First NameLast Name
Relationship to Participant*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Is there an additional person we should contact regarding participant details (medical needs, accessibility needs, trip information) such as house manager, QIDP, lead staff, case manager, etc?*
Please put first name, last name, relationship to participant, phone number and email below.
Emergency Contact Information

Please enter information for 2 additional people (not listed in parent/guardian/point of contact) who can be called in the event of an emergency.
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Relationship to Participant*
Emergency Contact 2

First NameLast Name
Emergency Contact 2 Phone Number

Area CodePhone Number
Relationship to Participant
Additional Questions
If you have any questions, please list here and a team member will follow up

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Adult Spring Trip 2023

Participant Demographic Information

Participant Medical Information

Trip Information

Parent/Guardian/Primary Point of Contact Information

Emergency Contact Information

Additional Questions