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Family Participant Form

JCC Boarding Pass: Family Participant Form

Step 1 of 3

33%

Trip Information
What trip are you filling out this form for?*
What JCC are you traveling with?*
General Family Travel Information
Parent 1*
First Last
Parent 2
First Last
How many children will be attending with you?*
- 1
- 2
- 3
- 4
Child 1*
First Last
Child 2*
First Last
Child 3*
First Last
Child 4*
First Last
Desired Room Arrangements
Please list your desired rooming arrangements. (Please note the arrangements are subject to the hotel's availability of different sizes and types of rooms)
Room 1
Room 2
Room 3
Emergency Contact Information
Full Name*
First Last
Relation
- Parent
- Child
- Aunt/Uncle
- Grandparent
- Cousin
- Friend
- Other
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternative Phone

Parent 1 Information
Gender*
- Male
- Female
- Other
Date of Birth*
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*
Expiration Date*
MM slash DD slash YYYY
Email
Current Address*
Street Address 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:*
Have you previously been to Israel?*
- Yes
- No
How many times?
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 other, please specify:*

Please list any specific dietary needs, allergies, or restrictions.
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:*
Parent 2 Information
Full Name
First Last
Gender
- Male
- Female
- Other
Date of Birth
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
Expiration Date
MM slash DD slash YYYY
Email
Is the home address and phone for parent 2 the same as parent 1?
- Yes
- No
Current Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Have you previously been to Israel?
- Yes
- No
How many times?
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 other, please specify

Please list any specific dietary needs, allergies, or restrictions.
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:

Child 1 Information
Full Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Nationality
Is their 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*
Expiration Date*
MM slash DD slash YYYY
Are the home addresses and home phone numbers for the children attending the trip the same as parent 1?*
- Yes
- No
Address
Street Address City State / Province / Region ZIP / Postal Code Country

If same as parent one, enter "Same as Parent 1" for the street address.
Email
Mobile Phone
Have they previously been to Israel?*
- Yes
- No
If yes, how many times?
If yes, when was the last trip?
If they have been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Does child 1 have any dietary needs?*
- Kosher
- Vegetarian
- Gluten Free
- Allergies
- Other
- No dietary restrictions
In yes, please specify

Please list any specific dietary needs, allergies, or restrictions.
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:
Child 2 Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Nationality
Is their 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*
Expiration Date*
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Mobile Phone
Email
Has this child previously been to Israel?*
- Yes
- No
How many times?
When was the last trip?*
If they have been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Do they have any dietary needs?*
- Kosher
- Vegetarian
- Allergies
- Gluten Free
- Other
- No dietary restrictions
If yes, 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:*
Child 3 Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Nationality
Is their 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*
Expiration Date*
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country

If same as parent one, enter "Same as parent 1" for the street address.
Mobile Phone
Email
Has this child previously been to Israel?*
- Yes
- No
If yes, how many times?
When was the last trip?
If they have been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Do they have any dietary needs?*
- Kosher
- Vegetarian
- Gluten Free
- Allergies
- Other
- No dietary restrictions
If 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:*
Child 4 Information
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Nationality
Is their passport valid for six months after the end of your visit?*
- Yes
- No
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*
Expiration Date*
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Mobile Phone
Email
Has this child previously been to Israel?*
- Yes
- No
How many times?*
If yes, when was your last trip?
If they been on an organized trip, was it planned through the JCC Association?
- Yes
- No
Do they have any dietary needs?*
- Kosher
- Vegetarian
- Allergies
- Gluten Free
- Other
- No dietary restrictions
If 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:*
Other Information
Other comments, special requests or anything else we should know about your family?
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!

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