Registration Form- 2024

Registration Form

We are pleased to inform you that your application to our 2024 Special Moments has been accepted. We look forward to welcoming you!
To confirm your participation please register by: June 4th at 10 pm.

Your reservation is not confirmed until this form has been submitted.

The program is geared to religious women, will include some musical entertainment and both indoor and outdoor activities.

Unfortunately, we are not able to accommodate babies on this retreat.

If you are experiencing trouble filling out this form from a tablet, please try using a desktop.
*At the current time, the security situation in Israel allows for the retreat to be held. Naturally, if circumstances change, we will need to reassess.*
Name:*

First NameLast Name
Home Number:*

Area CodePhone Number
Cell Phone Number:*
Format: (000) 000-0000.
Email Address:*
Verify Email Address:*
Roommate Request: (Two people per room)

First NameLast Name
*If you do not write your roommate request, you grant Chaim V'Chessed the right to place you in the room of our choice.
Emergency Contact Information:
Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Additional Comments:
Terms & Conditions:
Chaim V’Chessed shall be held unaccountable for any injury, suffering or loss, physical or monetary, which may be incurred due to participation in this retreat. Photos and videos may be used by Chaim V'Chessed.
Payment Method
The non-refundable registration fee is 250 NIS. Your registration is not complete until the registration fee has been paid.

Departure will be from Har Chotzvim on Wednesday, June 26 at 9:30 am sharp and we will be returning at approximately 10:30 pm on Thursday.

More details, including a suggested list of what to bring, will follow.
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Registration Form

Emergency Contact Information:

Terms & Conditions:

Payment Method