Or Ami 4th-6th Grade Retreat- Feb 2023

Retreat Details

Or Ami's annual 4th - 6th Grade Retreat is an opportunity for Or Ami youth and their friends to spend a weekend of fun at Camp Alonim in Simi Valley. 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.

Date: Friday, February 10 - Sunday, February 12, 2023

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

Pricing:
Or Ami Congregant: $290
Guest: $300
*This amount covers food, lodging, security, swag, transportation to and from Congregation Or Ami, staff, and programming for the weekend.

Helpful Links:
Frequently Asked Questions Packing List

Madrichim:

These 7th-12th graders will serve as counselors and junior counselors during the 4th-6th Grade Retreat. Our Madrichim will help plan programs, bond with retreat participants, and work to make the weekend a wonderful experience for everyone.

Sign up Madrichim (registration is the same for all ages).

Child Information

* Child's First Name:

* Child's Last Name:

Pronouns

* Grade:

* Birthdate:

Bunkmate Preference (Limit 1)

* I am a:

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

Click Here To Add Another Participant

* First Name:

* Last Name:

Pronouns

* Grade:

* Birthdate

* T-Shirt Size:

Bunkmate Preference (Limit 1)

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

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 allergies (including food) or specific medical concerns:

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

Please list any dietary restrictions your child may have including, but not limited to, vegetarian and gluten free:

* Please write your name here to complete this waiver:

I/we hereby give permission to my/our child participant in Congregation Or Ami's 4th-6th Grade 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 teen's participation in that activity. In addition, I, the undersigned parent/guardian of the above-named teen 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 teen, 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 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 and Jen Quick, 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 that 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:

* Please put your full name in the below to acknowledge.

I/we understand that there is a $50 cancelation fee once my/our registration is processed.

I/we understand that if I need to cancel my/our child's retreat registration less than 8 business days before the retreat, my/our registration fee is non-refundable. This includes unexpected illnesses as we are charged per participant 8 days before the retreat.

I/we understand if we register after the retreat deadline we understand that there is a possibility we do not receive swag.

* 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 4th-6th Grade Retreat is being underwritten with donations. Please consider supporting a part of this retreat with a donation:

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

*Note Swag is not guaranteed for those registering after the deadline

Total Retreat Cost:

Sun, April 20 2025 22 Nisan 5785

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