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A Historic Progressive Conservative Congregation in Valley Village, CA
A Dynamic Jewish Early Childhood Center Serving Children Ages 6 Weeks to Entering Pre-K
A Jewish Day School serving students in Grades TK-6
A Historic Progressive Conservative Congregation in Valley Village, CA

Civil Rights Journey Registration




Once your registration is submitted, you will receive a confirmation email.

We highly recommend that you purchase trip cancelation and travel insurance.

Personal Information
 
If not applicable, please write "N/A" in the space provided
Program
 
Registration deadline and non refundable deposit are due by July 26th.

Payment #2 is due August 16th and final payment is due August 31st.
 
Price is $1,250 per person for double occupancy.
Price is $1,500 per person for single occupancy.
Health Insurance Information
 
Medical Information
 
Please be honest in completing this information, as it may be important in the event we need to seek medical attention for you. The following information will be held in strict confidence: however, it will enable trip organizers to plan activities on a daily basis and to respond appropriately in case of a medical emergency. 
Please type your full name in the space provided.
Dietary Preference
 
Emergency Contact Information
 
Example: Friend, Spouse, Brother, etc.
Example: Friend, Spouse, Brother, etc.
Applicant Agreement and Understanding
 
1. The undersigned intends to participate in the Civil Rights Journey (“CRJ”) with Adat Ari El ("AAE") and Temple Ahavat Shalom ("TAS"). In connection with his or her participation, the undersigned hereby agrees to abide by the rules and regulations of CRJ.

2. The undersigned is providing medical information to the leadership of this trip on the forms enclosed with this Applicant Statement. The undersigned represents that all of the information contained in such forms is true and correct. All medications taken by the undersigned are detailed on the medical form or in any letters accompanying the medical form. The undersigned hereby authorizes the leadership of this trip to obtain treatment for him or her as it, in its sole and absolute discretion, deems necessary and advisable. The costs of any medical treatment provided shall be the responsibility of the undersigned.

3. The undersigned agrees to hold CRJ, AAE, and TAS (as well as any other organizations participating in any activities relating to CRJ and the leadership of these organizations, harmless from any claim, loss, damage, injury, liability or expense (including attorney’s fees) which the undersigned might sustain or incur in connection with, as a result of, or by reason of their participation in the CRJ or any of the activities relating thereto. The organizations sponsoring the CRJ operate the tour offered under this program only as agents of the airline, bus operators and others which provide the actual arrangements, and are not liable for any act, omission, delay, injury, loss, damage, or nonperformance occurring in connection with these arrangements.

4. Please note that we cannot provide for all special dietary needs including Kosher.
Your application is not complete without deposit payment on the subsequent page.
Tue, April 16 2024 8 Nisan 5784