Achshav Teen Winter Break Program

This program will be held from Sunday, December 27 – Thursday, December 31. Participants should plan to attend four Zoom sessions throughout the day, each day.

SAJ Members: please be sure that you are logged into your account before continuing.
You will know if you are logged in, because the fields below will be auto-filled with your contact information.

* First Name Parent/Guardian 1

* Last Name Parent/Guardian 1

Pronouns (ex: he/she/they)

* Email Parent/Guardian 1

* Phone Parent/Guardian 1

First Name Parent/Guardian 2

Last Name Parent/Guardian 2

Pronouns (ex: he/she/they)

Email Parent/Guardian 2

Phone Parent/Guardian 2

* Address

* City

* State

* Zip code

* Participant First Name

* Participant Last Name

* Participant Email

Participant Phone

Birthday

Age

Grade

School

* Pronouns

A pronoun is a word that substitutes for a noun; in this case, a word that substitutes for your name. We want to know what to call you! examples; he, she, they

Jewish identity

Affiliated synagogue, youth movement, camp (if applicable)

If possible, I’d like to be in a cohort with other:

* Why do you want to be a part of this program?

* Tell us about an issue you feel passionately about. What are some ways you’ve gotten involved with it? What are some ways you want to get involved in the future?

* What is one thing you’d like to learn in this program?

* Please provide a short bio so other participants can get to know you.

A sliding scale is a way to allow participants from diverse socio-economic backgrounds to join our program. The economic concept of sliding scale at its most basic: people pay as they are able to for services, events and items. We ask that you pay as much of that as you are able, as it will not only ensure that more participants who want to can attend, but will also ensure we are paying our educators and counselors appropriately for their time and efforts.

Think about your family income level, and what sorts of activities and programs you typically pay for. If you would typically consider going on vacation at this time, we ask that you perhaps put the money from that experience for your child towards this one.

How much will you be contributing towards Achshav: Jewish Social Justice Alternative Winter Break for this participant?

* We’re offering this program on a sliding scale of $100 - $360.

On the next page, we’ll ask your parents/guardians for credit card and payment information.

Fri, April 26 2024 18 Nisan 5784