Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Login
New User:
Register Now
Home
Village
Visitors
Services
Contact Us
About Us
Events
Donate
Home
Village
Visitors
Services
Contact Us
Or Ami At Disneyland 2024 (7th & 8th Grade)
Please verify reCaptcha before submitting the form.
Trip Details
A trip just for 7th and 8th graders!
Teens will meet at Or Ami for a lite breakfast and enjoy a full day at Disneyland.
Sunday, September 1
Drop off
at Or Ami at 5
:30 am
and
Pick up
at Or Ami at
11:00 pm
on Sunday night.
Cost for Or Ami Partners:
Early Bird Price: $310 (Before June 1st)
Regular Price:
$350
Cost for Non-Partners:
Early Bird Price: $335 (Before June 1st)
Regular Price:
$375
*Trip cost is non-refundable. Cost includes Disneyland ticket, transportation to and from, breakfast, lunch, dinner, snacks and swag! **Financial aid is available for those who need it, just reach out to Trip Coordinator Andrew Fromer (
andrew@orami.org
) for details.
Teen Information
*
Teen's First Name:
*
Teen's Last Name:
*
Teen's Email:
*
Teen's Cell:
*
Birthdate:
*
Teen's T-shirt Size:
Please Select One
Adult-XS
Adult Small
Adult Medium
Adult Large
Adult XL
*
I am a:
Please Select One
Or Ami Congregant
Friend of an Or Ami Congregant
Member of Another Synagogue
Community Member (Unaffiliated)
Parent/Guardian Information
Parent/Guardian #1
*
First Name:
*
Last Name:
*
Cell Phone:
*
Email:
Parent/Guardian #2
First Name:
Last Name:
Cell Phone:
Email:
Teen Emergency/Medical Information
*
Emergency Contact Full Name:
*
Emergency Contact Phone:
*
Contact's Relationship to Teen:
*
Physician's Name:
*
Physician's Phone:
*
Medical Insurance Company:
*
Insurance Policy Number:
Please indicate any allergies (including food) or specific medical concerns:
Please list any medications your teen is taking (medication name/dosage/frequency):
Please list any dietary restrictions your teen may have including, but not limited to, vegetarian and gluten free:
I/we hereby give permission for my/our teen to participate in Congregation Or Ami's 7th & 8th Grade Disneyland Trip, 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. Congregation Or Ami does not accept responsibility of loss, damage to, or theft of the teen’s property. Congregation Or Ami has blanket permission to transport participants offsite for any and all trips and events. Each participant that needs medication during the overnight and/or trip will bring to the drop off location this medication in a Ziplock bag in the original prescription bottle and written instructions for distribution. The Trip Coordinator, Andrew Fromer, or any Or Ami clergy member may expel a participant for behavior harmful or inappropriate to the trip community. Please note that if a trip participant is sent home early for behavior reasons, no refund will be given. I understand that part of the trip experience involves activities and group interactions that may be new to my/our teen, and that the activities may come with uncertainties beyond what my/our teen 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 teen I realize that no environment is risk free, and so I have instructed my/our teen on the importance of abiding by Or Ami’s rules, and my/our teen 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 TERMS ABOVE (WRITE FULL NAME):
*
Waiver signed by:
My typed name here serves as my signature.
I/we understand that my/our trip registration fee is non-refundable.
*
Non-Refundable Acknowledged by:
My typed name here serves as my signature.
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. Congregation Or Ami is subventing part of the cost to help make the trip more accessible. Please consider making a tax-deductible donation below to help us offset the cost (thank you!)
Tax Deductible Donation
Please Select One
Yes, I would like to sponsor snacks ($25)
Yes, I would like to sponsor meals ($50)
Yes, I would like to sponsor some swag ($75)
Yes, I would like to sponsor part of the bus trip ($100)
Yes, I would like to sponsor a Disneyland ticket ($150)
Yes, I would like to sponsor another participant ($350)
No, I do not wish to donate at this time
Total Trip Registration Cost:
Sun, April 28 2024 20 Nisan 5784