Family Retreat 2022

Retreat Details

When: Friday, October 21 - Sunday, October 23, 2022

Where: Camp Alonim (1101 Peppertree Lane, Brandeis, CA 93064)

What: A retreat for the whole family! We'll celebrate Shabbat together and enjoy a weekend of hiking, sports, arts, relaxing, and connecting with friends and clergy.

Cost: The cost of the retreat is $160 per person (anyone above 2 years old). This price includes:

2 nights, 3 days lodging in a clean, air-conditioned, furnished cabin with linens provided
3 days of full meals (2 dinners, 2 breakfasts, 2 lunches, with snacks available 24/7)
Planned and loosely structured activities for families to do together, plus adult-only and kid-only activities
Shomrim (adult counselor/babysitters) who will watch the cabins while kids sleep so adults can enjoy adult-only programming
Facility access (including hiking trails, group campfire+smores, petting zoo area, informative staff that live on site)

**Covid protocols are ever-changing. We will keep registrants up to date when and if protocols change. For now, families will be in their own cabin (no shared bathrooms), majority of programming will be outside and masks will be optional when inside buildings.

Registration

* Please select the number of people in your family that will be attending:

$160 per person above the age of 2.

Youth Information

Please fill out the following information for all children attending the retreat. (Click plus sign to add information for multiple children.)

* First Name:

* Last Name:

* Grade:

* Birthdate

T-Shirt Size:

Please indicate any allergies (including food) or specific medical concerns:

Please list any medications your child is taking (medication name/dosage/frequency):

Please list any dietary restrictions (such as vegetarian, gluten free, etc.):

CLICK TO ADD MORE CHILDREN

* First Name:

* Last Name:

* Grade:

* Birthdate

* T-Shirt Size:

Please indicate any allergies (including food) or specific medical concerns:

Please list any medications your child is taking (medication name/dosage/frequency):

Please list any dietary restrictions (including vegetarian, etc.):

Parent/Guardian Information

Please fill out the following information for all parents attending the retreat.

Parent/Guardian #1

* First Name:

* Last Name:

* Cell Phone:

* Email:

T-Shirt Size:

Please list any dietary restrictions (such as vegetarian, gluten free, etc.):

Parent/Guardian #2

First Name:

Last Name:

Cell Phone:

Email:

T-Shirt Size:

Please list any dietary restrictions (such as vegetarian, gluten free, etc.):

Family Emergency & Medical Information

* Emergency Contact's Full Name:

* Emergency Contact's Phone:

* Contact's Relationship to Child:

* Children's Physician's Name:

* Children's Physician's Phone Number:

* Medical Insurance Company:

* Insurance Policy Number:

* Please write full name(s) to acknowledge liability waiver below

I/we hereby give permission to my/our child to participate in Congregation Or Ami's Family Retreat, and do release Congregation Or Ami, its Rabbis, cantor, educators, board members. leaders, and its representatives from all liability arising out of my/our child’s participation, and my/our participation, in that activity. In addition, I/we, the undersigned parent(s)/guardian(s) of the above-named child, do further assign Congregation Or Ami and its authorized representatives as agents for the undersigned to consent to any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care for the above-mentioned child, or for me/us if I/we am/are incapacitated, which is to be rendered under the general or specific supervision of any licensed physician or dentist under the provision of the California Medicine Practice Act and Dental Practice Act or the staff of a licensed hospital, whether such diagnosis, examination or treatment is rendered at the office of said physician or such hospital. It is understood that the authorization is given in advance of any specific examination, diagnosis, treatment or hospital care being required, and is given to provide authority and power of our above named agents to give specific consent to any and all such examinations, diagnosis, treatment or hospital care with the aforementioned physician in the exercise of his/her best judgement may deem advisable. THE AUTHORIZED IS GIVEN PURSUANT OF SECTION 25.8 OF THE CIVIL CODE CALIFORNIA. The hosting camp and Congregation Or Ami does not accept responsibility of loss, damage to, or theft of the child’s or my/our property. The camp and Congregation Or Ami has blanket permission to transport my/our child off campgrounds for any and all trips, competitions and events. I/we understand that if my/our child needs medication during the retreat, I/we will be solely responsible to store and administer such medication to my/our child. I/we understand that if I/we do not want such responsibility, I/we will bring to the drop-off site any such medication in a Ziplock bag in the original prescription bottle and written instructions for distribution. The Retreat Coordinator, Rabbi Julia Weisz, or any other Or Ami clergy member may expel me/us, or my/our child for behavior harmful or inappropriate to the retreat community. I/we understand and agree that if my/our child or I/we am/are expelled early for behavior reasons, no refund will be given. I/we understand and agree that part of the retreat experience involves activities and group interactions that may be new to me/us and to my/our child, and that the activities may come with uncertainties beyond what I/we or my/our child is/are used to dealing with at home. I am/we are aware that of these risks, and I am/we are assuming them on behalf of myself/ourselves and my/our child, and I/we realize that no environment is risk free, and so I/we understand, and I/we have instructed my/our child on, the importance of abiding by the camp’s rules, and I/we and my/our child both agree that we are familiar with these rules and will obey them. I/WE HAVE READ AND FULLY AGREE TO THE MEDICAL/LIABILITY TERMS ABOVE (please write full name(s) above to acknowledge):

* Please write your full name in the box to acknowledge cancellation policy below

I/we understand that there is a $50 cancellation fee once my/our registration is processed. I/we also understand that if I need to cancel my/our retreat registration less than 8 business days before the retreat, my/our registration fee is non-refundable.

We understand that times are tough for some families. Our hope is that the generosity of some families will help offset the cost for other families. We are all here for each other. This Family Retreat is being underwritten with donations. Please consider supporting a part of this retreat with a donation:

Total Retreat Cost:

Thu, April 25 2024 17 Nisan 5784