Kavanah Registration Form 2025-2026

For Jewish high school students ready to take action! Teens plan and lead service projects, learn about advocacy, meet local and state leaders, and participate in a trip to the Massachusetts State House in Boston. There will be four sessions between autumn and spring; exact program dates will be chosen with participants input to ensure accessibility.
Participants Full Name*
Participant's Age; School Attending; Grade*
Participants Phone Number*
Participants Email Address*
example@example.com
Participants Home Address *
Street, City, State & Zip
Special Needs and Accommodations: Do you have any special needs or require accommodations? If yes, please specify? If no, write N/A.*
Examples might include dietary restrictions, allergies, mobility needs, etc.
Participant's Availability: Before we finalize our schedule, we wanted to consult all participants about availability. Please list any dates between October 2025 and April 2026 that would not work for you.*
Participants Referral Source: How did you hear about this program?*

Participant's Goals: As you think about joining this program, what are you most hoping to accomplish?*
Participants Interests: What inspired you to register for this program? For instance, is there an issue you feel strongly about, a cause for which you would like to advocate or a topic you would like to explore further?*
Participant's Promise: I commit to attend all meetings barring an unforeseen emergency event*

Yes, I commit to attending all scheduled meetings
Parent/Guardian 1 Full Name*
Parent/Guardian 1 Relationship to Children*
Parent/Guardian 1 Phone number*
Parent/Guardian 1 Email Address*
example@example.com
Parent/Guardian 1 Home Address (if different from the participant)*
(Street, City, State, & Zip)
Parent/Guardian 2 Full Name
Parent/Guardian 2 Relationship to Children
Parent/Guardian 2 Phone number
Parent/Guardian 2 Email Address
example@example.com
Parent/Guardian 2 Home Address (if different from the participant)
(Street, City, State, & Zip)
Parent/Guardian Media Release: As parent/legal guardian, I give Jewish Family Service (JFS) permission to use my child's likeness (photo, video, etc for JFSWM publications, promotions, website, press releases, or other purposes. I agree. I disagree; do not use my child's image.*

I agreeI disagree; do not use my child's image
Parent/Guardian Waiver: I understand there are risks, including travel to Boston, and agree to release and hold harmless JFS, its employees, and volunteers ('Covered Parties') from any claims of injury, illness, or damages.*

Yes, I agree to release and hold harmless JFS, its employees, and volunteers ('Covered Parties') from any claims of injury, illness, or damages.
* Parent/Guardian Permission: As parent/legal guardian, I give permission for my child to participate in program*

Yes, I give my child permission to participate in this program.
Should be Empty: