Double Participant Form

JCC Association of North America

We lead and connect the JCC Movement, advancing and enriching North American Jewish life.

JCC Boarding Pass: Double Participant Form

Trip Information
What trip are you filling out this form for?*
What JCC are you traveling with?*
Participant 1 Information
Full Name*
First Last
Gender*
Birth Date*
MM slash DD slash YYYY
Nationality
Is your passport valid for six months after the end of your visit?*
- Yes
- No
Required in order to be eligible for the health insurance coverage.
Please contact your trip coordinator when you have a valid passport. A valid passport is required in order to ensure health insurance coverage.
Passport Number*
Passport Expiration Date*
MM slash DD slash YYYY
Email*
Enter Email Confirm Email
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Home Phone*
Are you flying with the group?*
- Yes
- No
If not, please state travel arrangements:
Do you have other relatives coming on this trip? (grandparents, aunts, uncles, cousins, etc)*
- Yes
- No
If yes, please list their last name(s):
Have you previously been to Israel?*
- Yes
- No
When was your last trip?
If you have been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Do you have any dietary needs?*
- Kosher
- Vegetarian
- Gluten Free
- Allergies
- Other
- No dietary restrictions
If allergies or other was selected, please specify:
Any special medical condition or health restriction we need to be aware of?*
- Yes
- No
Please note:
All trips involve quite a bit of walking both around historical sites, modern cities and in nature.
Health insurance is not available for individuals who have been diagnosed with cancer in the past 5 years. Health insurance does not cover pregnancy.
If yes, please explain:
Participant 2 Information
Name*
First Last
Gender*
Birth Date*
MM slash DD slash YYYY
Is your passport valid for six months after the end of your visit?*
- Yes
- No
Required in order to be eligible for the health insurance coverage.
Please contact your trip coordinator when you have a valid passport. A valid passport is required in order to ensure health insurance coverage.
A
Passport Number*
Expiration Date*
MM slash DD slash YYYY
Email*
Enter Email Confirm Email
Is your contact information the same as participant 1?*
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone*
Are you flying with the group?*
- Yes
- No
If not, please state travel arrangements:
Do you have other relatives coming on this trip?*
- Yes
- No
(Grandparents, aunts, uncles, cousins, etc)
If yes, please list their last name(s):
Have you previously been to Israel?*
- Yes
- No
If yes, when was your last trip?
If you have been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Do you have any dietary needs?*
- Kosher
- Vegetarian
- Gluten Free
- Allergies
- Other
- No dietary restrictions
If you've selected allergies or other, please specify:
Any special medical condition or health restriction we need to be aware of?*
- Yes
- No
Please note:
All trips involve quite a bit of walking both around historical sites, modern cities and in nature.
Health insurance is not available for individuals who have been diagnosed with cancer in the past 5 years. Health insurance does not cover pregnancy.
If yes, please explain:
Emergency Contact
For both participants
Name*
First Last
Relation to Participants
Email*
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Alternative Phone
Other comments, special requests or anything else we should know about your group?
TERMS OF PAYMENT

The JCC Association will not charge a cancellation fee in the event the trip is cancelled due to war or other extreme security situation in a month or less prior to the trip. This applies to a cancellation instructed only by Israel’s official authorities.

Additional Cancellation Fees for Land Costs.

Participants would be responsible for any additional cancellation fees imposed by the hotels or other suppliers for cancellations within two months of the trip start date. We strongly suggest that participants purchase travel insurance to cover any cancellation fees should they be incurred. These additional cancellation fees are charged to the sponsoring JCC and are payable to the JCC Association up to two months after the end of the trip.

Thank you! See You Soon! – Todah! L’hitraot!

JCC Boarding Pass: Double Participant Form

Trip Information

Participant 1 Information

Participant 2 Information

Emergency Contact

TERMS OF PAYMENT

Additional Cancellation Fees for Land Costs.

JCC Association of North America

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Continental Sponsor

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JCC Boarding Pass: Double Participant Form

Trip Information

Participant 1 Information

Participant 2 Information

Emergency Contact

TERMS OF PAYMENT

Additional Cancellation Fees for Land Costs.

JCC Association of North America

Quick Links

Centers of Excellence

Continental Sponsor