2023 Edward Freedman Congregational Retreat

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EDWARD FREEDMAN CONGREGATIONAL RETREAT

March 31 - April 2, 2023

Join Shaarai Shomayim friends, old and new,
at the beautiful Capital Retreat Center!

Cost to Congregants:

$325 per adult/teen (13 and older)
$250 per child (ages 5-12)
$40 per child (under age 5)
$450 single room for those who prefer not to have a roommate

Note: Non-refundable deposit of $100 per family or $50 per single is required at time of on-line registration. The balance is due by March 1, 2023.

REGISTRATION INFORMATION:

Complete the information below as it pertains to each member of your family who will be attending the 2023 Congregational Retreat.

* STREET ADDRESS

* CITY

* ZIP CODE

# of Adults/Teens Attending (13 and older)

$325 per adult/teen

# of Children Attending (ages 5 - 12)

$250 per child (ages 5 - 12)

# of Children Attending (under age 5)

$40 per child (under age 5)

Single Room Reservation

$450 single room for those who prefer not to have a roommate (not for families who want to be in the same room).

ADULT #1:

* FIRST NAME

* LAST NAME

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

ADULT #2:

FIRST NAME

LAST NAME

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

CHILD/TEEN #1:

FIRST NAME

LAST NAME

DATE OF BIRTH

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

CHILD/TEEN #2:

FIRST NAME

LAST NAME

DATE OF BIRTH

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

CHILD/TEEN #3:

FIRST NAME

LAST NAME

DATE OF BIRTH

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

CHILD/TEEN #4:

FIRST NAME

LAST NAME

DATE OF BIRTH

PHYSICAL CONSIDERATIONS

Please list any physical accommodations, medical conditions, etc.

FOOD OR ALLERGY CONSIDERATIONS

Please list any allergies and/or dietary needs

IN THE CASE OF AN EMERGENCY:

Please provide a contact in the case of an emergency.

* EMERGENCY CONTACT #1:

Name, Relationship, Phone Number

REQUEST TO USE PHOTOGRAPH/VIDEO:

Photos/videos of participants are often used in the Temple's public relations programs. Choose "No" if you DO NOT want your photo to be represented in newspapers, TV, or the Temple's web communications. Please note that this includes posting pictures on all of the Temple's social media, including the website, Facebook, Instagram, and Twitter.

CHECK BOX IF DECLINING USE OF PHOTOS/VIDEOS:

NO; Shaarai Shomayim may not use the photos/videos

MAKE A CONTRIBUTION:

Our goal is to ensure that every member of Shaarai Shomayim
who wants to attend the retreat is able to join us.
Please consider making a donation to our retreat fund to help subsidize the
costs for those who may not be able to otherwise afford the experience.

Please complete the "Donation Box" below.

We appreciate your additional support!

DONATION BOX

Enter the amount of additional money you would like to contribute to the Edward Freedman Congregational Retreat.

TOTAL DUE:

Thank you for registering for the Shaarai Shomayim Congregational Retreat!

Wed, February 8 2023 17 Sh'vat 5783