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Open to 8th-12th grade boys and girls.

Leaving on the evening of Thursday, February 7th  
and return Sunday, February 10th. 

To reserve a space:

It is essential that this entire application form, as well as the Parent Consent form  
 and Code of Conduct form, is complete.

All registration forms must be accompanied with payment
of $160 ( $185 after January 4th) which includes  
registration, activities, and transportation.  

No application will be processed without all required documents and signatures. 

 

SHABBATON REGISTRATION
Participant's First Name Participant's Last Name  
Participant's 
Address
City, State, Zip
Participant's 
Phone Number
Participant's E-mail Address
Participant's Gender Male Female

Grade and School

Allergies D.O.B.
PARENT INFO
Father's Name Father's Cell
Father's E-Mail Mother's Name
Mother's Cell Mother's E-mail
I would like to help sponsor a teen who lacks the funds to participate.  18 36 75  100   Yes, my child wants to get involved in planning and recruiting for the Shabbaton.
ADDITIONAL CONSENT FORMS  (Required)

Please download these forms after you complete the registration 

1)  Participant Code of Conduct
2)  Parent Consent Form

 
 
PAYMENT INFO
  $160 ($185 after January 4th) - For Teen Registration & Transportation
  Please also add  as a scholarship for another teen who lacks funds.
Please confirm the total to be charged to your credit card:  
Name on Card:  Card Number: 
Card Type:  Exp. Date:      
PARENTAL PERMISSION
I give my son/daughter  permission to participate in the National Teen Shabbaton.
 Signature:   Date: 



 



 

Problems with this form?  Please call (703) 370-2774 or e-mail rabbinewman@gmail.com