4th-6th Grade Day Retreat 2022

Retreat Details

Covid is not going to stop us from having a fun time with our 4-6th grade Or Ami friends.

New this year, 4th - 6th Grade DAY Retreat is an opportunity for youth from all of Or Ami’s learning programs, including Kesher 3.0 and Mensch-ify, to spend a DAY of fun at Camp Alonim in Simi Valley. Friends from outside Or Ami are also invited! All activities are designed to promote a “camp” atmosphere. Sports, arts and crafts, hikes, and music are just some of the activities we will be sharing together. Please Note: All programming will take place outdoors.

Date: Saturday, February 12, 2022

Timing:
9:30am: Drop off and snack
10:00am: Retreat begins
7:15pm: Retreat ends
7:30pm: Pick up participants

Location: Camp Alonim (1101 Pepper Tree Ln, Simi Valley, CA 93064)

Pricing (Should the retreat be postponed due to COVID concerns, all payments will be fully refunded.)
Or Ami Congregant: $50
Guest: $150
*Price includes swag!

**Actual cost per participant is $175

This day retreat is being underwritten with donations. Please consider supporting this program with a donation:

If your child is unable to attend, but you still would like to make a donation without registering, please do so using the form at orami.org/donate. Thank you!

7th-12th Graders:

9th-12th Grade Madrichim and 7th/8th Grade Madrichim-in-Training will serve as counselors and junior counselors at the 4th-6th Grade Retreat. They will help plan programs, bond with retreat participants, and work to make the weekend a success for all.

Sign up 7th-12th graders below (registration is the same for both campers and counselors).

Child Information

* Child's First Name:

* Child's Last Name:

* Grade:

* Birthdate:

* I am a:

If you found out about the retreat from a friend or another organization, please list here:

Parent/Guardian Information

Parent/Guardian #1

* First Name:

* Last Name:

* Cell Phone:

* Email:

Parent/Guardian #2

First Name:

Last Name:

Cell Phone:

Email:

Child Emergency/Medical Information

* Emergency Contact Full Name:

* Emergency Contact Phone:

* Contact's Relationship to Child:

* Physician's Name:

* Physician's Phone:

* Medical Insurance Company:

* Insurance Billing Policy Number:

Please indicate any dietary restrictions, allergies or specific medical concerns:

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

If your child is only participating for part of the day (arriving late or leaving early), please let us know here:

* I/we hereby give permission to my/our child participant in Congregation Or Ami's 4th-6th Grade DAY 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 in that activity. In addition, I, the undersigned parent/guardian 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, 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 judgment 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 property. The camp and Congregation Or Ami has blanket permission to transport campers off campgrounds for any and all trips, competitions and events. There is no fee reduction for late arrival or early departure from the retreat. Each retreat participant that needs medication during the retreat will bring to the bus pick up location this medication in a Ziplock bag in the original prescription bottle and written instructions for distribution. The Retreat Coordinators, Rabbi Julia Weisz, or any other Or Ami clergy member may expel a camper for behavior harmful or inappropriate to the retreat community. Please note that if a retreat participant is sent home early for behavior reasons, no refund will be given. I understand that part of the retreat experience involves activities and group interactions that may be new to my/our child, and that the activities may come with uncertainties beyond what my/our child is used to dealing with at home. I am/we are aware of these risks, and I am/we are assuming them on behalf of my/our child I realize that no environment is risk free, and so I have instructed my/our child on the importance of abiding by the camps’ rules, and my/our child and I both agree that he or she is familiar with these rules and will obey them. I HAVE READ AND FULLY AGREE TO THE MEDICAL/LIABILITY TERMS ABOVE (write full name in box):

* A hoodie sweatshirt will be provided as part of this weekend retreat. Please select your child's shirt size.

Total Retreat Cost:

(Should the retreat be postponed due to COVID concerns, all payments will be fully refunded.)

Thu, April 25 2024 17 Nisan 5784