Information Sheet (as of 9/16/2009)

Temple Israel Confirmation Class Trip to Washington D.C.
Information Sheet (as of 9/16/2009)
What:
L’Taken Seminar sponsored by the Religious Action Center of Reform Judaism (RAC)
When:
Friday, March 5 – Monday, March 8, 2010
Where:
Marriott Crystal Gateway, 1-703-920-3230
1700 Jefferson Davis Highway, Arlington, VA 22202
Transportation:
Friday, March 5, 2010
Meet at the airport at 8:00 AM at the group sign-in desk on the underground transportation level
at the base of the escalators and sign-in with trip staff.
Bring a bag lunch (and money for a drink to purchase AFTER we go through security)
Leaving MSP
10:15am
flight # Northwest Airlines 1704
Arriving Reagan National
1:46pm
Worldperks Mileage: You may present your Worldperks card at the time of check-in.
Card must be in the name of the passenger traveling.
We travel by bus within the D.C. area.
Monday, March 8, 2010
Parents/guardians meet us at the baggage carousel, lower level. Sign-out with trip staff.
Leaving Reagan National
6:30pm
flight # Northwest Airlines 1711
Arriving MSP
8:19pm
Chaperones: Rabbi Jared Saks, Wendy Schwartz, Aaron Kesher, Denise Fogel
Housing:
Students will be staying 4 to a room with 2 double beds. Roommate assignments will be handed
out at the hotel. There will be no switching of rooms.
Costs:
$925 per person (includes seminar program, meals, hotel, bus, airfare and baggage fees for 1 bag)
Scholarships are available. Contact Rabbi Saks, 612-374-0315, [email protected]
Refunds:
Should you cancel for any reason, you will be refunded for any expenses not incurred at that time.
Airfare is NON-REFUNDABLE and NON-TRANSFERABLE.
Deadline:
Wednesday, December 9, 2009 (Registration & payment due)
(Students must be signed up by December 9th to go on the trip.)
For More Information:
Rabbi Jared Saks, 612-374-0315 or e-mail [email protected]
Wendy Schwartz, Confirmation Coordinator
612-374-0344 or e-mail [email protected]
Emergency Contacts:
If you have a family emergency during the trip, please call one of us first (before
calling your child.)
Rabbi Jared Saks cell: 612-619-1963
Wendy Schwartz cell: 612-964-9924
1
L'Taken Seminars
A Teen Social Justice Program in Washington, DC
A program of the Religious Action Center of Reform Judaism
L'taken olam b'malchut Shaddai
To repair the world under the realm of the Eternal
Transforming Jewish Values into Political Reality
The Bernard and Audre Rapoport L'Taken Social Justice Seminar is an intensive four-day study kallah in Washington, DC,
focusing on Jewish values and social justice. Every year more than 100 congregations from across the country bring their
high school students to participate in this exciting event. Each weekend brings together students from around the country
to explore public policy and social activism through a Jewish lens. This unique Washington opportunity enables students to
hear from experts both inside and outside the Jewish community. Lobbyists, national leaders and special interest group
leaders—speak to, and with, L'Taken participants. Every L'Taken Seminar covers several different issue areas in a variety of
interactive formats. Each seminar includes an opportunity for students to tour the U.S. Holocaust Memorial Museum and
participate in Havdalah services at one of the memorials. Students also sample the vibrancy of Georgetown and other
exciting areas of Washington, DC.
High school students from across the country participate in:
•
Torah - Jewish Learning
Learning Jewish social justice values, the legislative
process, and the political and the social reality we
need to transform
•
Avodah - Prayer
Connecting holiness and justice through creative
worship services
•
Gemilut Chasadim - Action
Going to Capitol Hill and discussing the issues they
have just studied by lobbying their Senators' and
Representatives' offices on the issues they have just
studied
Every L'Taken seminar covers 10-12 different issue areas in
a variety of interactive formats. These issues, ranging from
AIDS to women's rights, from Israel to environmental and
economic justice, are selected based on the current
legislative agenda.
Religious Action Center of Reform Judaism
The Religious Action Center of Reform Judaism (RAC) has
been the hub of Jewish social justice and legislative activity
in the Washington, DC, area for more than 40 years. It has
educated and mobilized the American Jewish community on
legislative and social concerns as an advocate in the
Congress of the United States on issues ranging from Israel
and human rights to a woman's right to choose and civil
rights, to international peace and religious liberty. The RAC
is the Washington office of the Union for Reform Judaism
and the Central Conference of American Rabbis (CCAR),
encompassing 1.5 million Reform Jews and 1,800 Reform
rabbis in more than 900 congregations throughout North
America. To learn more about the RAC, visit our website
at www.rac.org
Congregations
Participating in March 2010
City
ST
Beth El Temple Center
Beth Elohim
Beth Israel
Beth Tikvah Congregation
Central Reform Congregation
Congregation Beth Israel
Congregation Emanuel
Congregation Har HaShem
Hevreh of Southern Berkshire
North Shore Congregation Israel
Sinai Temple
Temple Adath Israel
Temple Beth Sholom
Temple B'nai Chaim
Temple Emanuel Beverly Hills
Temple Isaiah
Temple Isaiah
Temple Isaiah
Temple Israel of Hollywood
Temple Shaaray Tefila
Temple Shalom
Temple Shalom of Newton
Temple Solel
University Synagogue
Westchester Reform Temple
Temple Shir Tikva
Temple Israel
Belmont
Brooklyn
Portland
Hoffman Estates
St. Louis
San Diego
Denver
Boulder
Great Barrington
Glencoe
Springfield
Lexington
Miami Beach
Georgetown
Beverly Hills
Lafayette
Lexington
Fulton
Los Angeles
New York
Norwalk
West Newton
Paradise Valley
Los Angeles
Scarsdale
Wayland
Minneapolis
MA
NY
OR
IL
MO
CA
CO
CO
MA
IL
MA
KY
FL
CT
CA
CA
MA
MD
CA
NY
CT
MA
AZ
CA
NY
MA
MN
2
Temple Israel Confirmation Class Trip to Washington D.C.
Packing List
Clothing:
♦ Nice “Temple” clothes for Friday evening services
♦ Casual clothes for Saturday and Sunday programs
(provide options for layers- the hotel can be sometimes hot and sometimes cold)
♦ Business attire for Monday’s trip to Capitol Hill
boys: tie, dress slacks, jackets preferred, dress shoes (no sneakers)
girls: dresses/skirts or dress slacks and dress shoes (no sneakers, NO MIDRIFFS)
♦ pajamas/night gowns
♦ Coat, hat, gloves (We will be out doors on walking tours for some meals and sight seeing)
♦ Kippah and Tallit: if you would normally wear them at Shabbat services, then bring them
Toiletries:
Liquids, Gels, and Lotions: Or similar items in containers of 3.4 ounces/100 ml or less must fit
comfortably in ONE, QUART-SIZE, clear plastic, zip-top bag if in carry-on luggage. There is
no volume limit to these items if they are in checked luggage.
Medications: please bring only the essential medications in original prescription bottles (and have written on
your trip registration.) We will have a small first aid kit with us.
Cell phones: We encourage that you bring a cell phone for safety and communication. Cell phones and beepers
must be turned off during programming.
Electronics:
Game boys, portable CD players, etc. are at your own risk. Electronic games must be left in the
rooms.
Laptop Computer: If you are comfortable bringing your laptop it will make your speech writing easier. Temple
brings one laptop and a portable printer.
Lithium-style Batteries: Spare lithium batteries such as laptop & DVD player rechargeable
batteries and lithium metal AA style batteries, are allowed in CARRY-ON BAGS ONLY. Prior
to going through the TSA security checkpoint, please make sure to place each battery in your
carry-on bag in its own protective case, plastic bag, or package; or place tape across the battery's
contacts to isolate terminals.
Extra Money: You only need to bring money for souvenirs. All meals are included in your trip fee.
Baggage Fees: Baggage fees for ONE (1) checked bag are included in the trip cost.
Luggage:
You are only allowed one (1) carry-on bag and one (1) checked bag. You will be responsible for
carrying your own luggage. Checked bags cannot weigh more than 50 lbs. Carry-on bag cannot
weigh more than 40 lbs. and must fit under the seat.
You must leave your checked bag UNLOCKED for the duration of airline travel. (You may use
straps and buckles to secure the suit case but security officials must be able to open your bag in
your absence.)
Please plan accordingly, do not pack valuables in checked luggage, and do not bring unnecessary
valuables.
♦ Bring a bag lunch in disposable containers to eat on the airplane.
We will not be stopping at fast food restaurants in the airport to get food.
3
Temple Israel Confirmation Class Trip to Washington D.C.
Finding Your Congressional District
On your trip registration you are required to provide us with your Congressional district and Representative so
that arrangements can be made for students to meet with their own representatives. If you do not know your
district and representative, here’s how you can find it: Please be sure to enter your Congressional district and
Representative on your trip registration form.
Minnesota District Finder
http://www.gis.leg.mn/mapserver/districts/index.html
Enter Address, City, State, Zipcode:
2324 Emerson Ave S, Minneapolis, MN 55405
Do Not Display Map
search
reset
PLEASE NOTE: Due to limitations in the data, the District Finder may incorrectly identify the district for this address. Please consider
checking the map to determine if your address was located correctly. This especially applies to zip code only searches.
Address: 2324 Emerson Ave S, 55405-2635
Find New Address | GIS Home Page
State Representative
Margaret Kelliher
60A
DFL
State Senator
Scott Dibble
60
DFL
U.S. Representative
Keith Ellison
5
DFL
U.S. Senator
Amy Klobuchar
U.S. Senator
Democrat
U.S. Senator
Al Franken
U.S. Senator
Democrat
4
Temple Israel Confirmation Class Trip to Washington D.C.
Issue Selection for Lobbying Speeches
Your Name ____________________________________________________________________
Please mark your 1st and 2nd choice for an issue for which you would like to lobby your Representative or Senator.
Friday Night:
Economic Justice (Homelessness, Hunger, Poverty)
Saturday Morning:
Campaign Finance Reform
Assault Weapons Ban
Program Shuk Round One (Saturday Night): (You will choose ONE to attend)
Carbon Game
Give me Health Care, or Give me Death
I Want to Live in America
Reducing the Rollback of Reproductive Rights
Tough Choices in International Relations
With Justice for All: Civil Rights in the Workplace
Sunday Morning:
Israel and the Peace Process: Loving Israel – Seeking Peace
Program Shuk Round Two (Sunday Late Morning): (You will choose ONE to attend)
The Energizer Generation
I Want to Live in America
Save a Life, Save the World: The Global AIDS Crisis in Perspective
Reducing the Rollback of Reproductive Rights
With Justice for All: Civil Rights in the Workplace
To Teach or to Preach? That is the Question…
_____ Senator Klobuchar
_____ Senator Franken
For Chaperone Use Only:
_____ Congressman Paulsen
_____ Congressman Ellison
_____ Congresswoman McCollum
5
Issues
The RAC works in over sixty issues areas. Use this section to find
descriptions of RAC's position on any of the following topics, as well as
listings of publications, press releases, and programs to help you
understand the issues and get involved. http://rac.org/advocacy/issues/
Affirmative Action
Africa
Arms Control
Bilingual Education
Bio-Ethics
Campaign Finance Reform
Child Soldiers
Children’s Issues
Civil Liberties
Civil Rights
Clean Water
Climate Change and Global Warming
Conflict Diamonds
Crime and Criminal Justice
Darfur
Death Penalty
Debt Relief and Jubilee 2000
Disability Rights
Domestic Violence
Economic Justice
Education
Election Reform
Endangered Species
Environment
Environmental Health
Environmental Justice
Fair Trade Coffee
Foreign Aid
Forest Issues
Gay, Lesbian, Bisexual & Transgender
Equal Rights
Global AIDS
Gun Control
Hate Crimes
Health Care
HIV/AIDS
Housing and Homelessness
Human Rights
Human Trafficking
Hunger
Immigration and Refugees
Intelligent Design & Creationism
Interfaith Affairs
Israel
Judicial Nominations
Labor Issues
Living Wage
Mental Health
Minimum Wage
Privacy
Race Relations
Religious Persecution
Reproductive Rights
School Prayer
School Vouchers
Separation of Church, State and
Charitable Choice
Sexuality Education in Public Schools
Smart Growth and Sustainability
Smoking
Social Security
Socially Responsible Investment
Stem Cell Research
Substance Abuse
Sudan & Darfur
Takings Legislation
The Holocaust
Torture: A Jewish Perspective
U.S. Foreign Policy
Welfare Reform Reauthorization
Women’s Health
World Jewry: Ethiopian Jewry and
Soviet Jewry
© Religious Action Center of Reform Judaism, 1996-2009
6
The Religious Action Center pursues social justice and religious liberty by mobilizing the American
Jewish community and serving as its advocate in the nation’s capital
2027 Massachusetts Ave., NW
at Kivie Kaplan Way
Washington, DC 20036
Phone (202) 387- 2800
SAMPLE
Bernard and Audre Rapoport
L’Taken Social Justice Seminar
A Jewish Social Justice Program in Washington, DC
January 11 – January 14, 2008
“What is it that the Eternal One requires of you?
Only this: to do justice, to love mercy, and to walk humbly with your God.” Micah 6:8
Friday, January 11, 2008
Marriott Crystal Gateway
1700 Jefferson Davis Highway
Arlington, Virginia 22202
Phone: (703) 920-3230
6:15 PM
Welcome and Introductions (Salons A, B, C)
Rabbi Michael Namath, Program Director
Barbara Weinstein, Legislative Director
Katie Dochen & Cara Fisher, Conference Planners
RAC Legislative Assistants and their Groups:
Joanna Blotner: Temple Emanuel, Atlanta, GA
Jonah Perlin: Temple Judea, Coral Gables, FL; Congregation Beth Shalom of the Woodlands, The Woodlands,
TX
Kate Bigam: Beth David Reform Congregation, Gladwyne, PA; Main Line Reform Temple, Wynnewood, PA;
Temple Sholom in Broomall
Debra Eichenbaum: Temple Emanu-El, Westfield, NJ, Temple Beth El, Closter, NJ
Jessie Weiser: Temple B’nai Chaim, Georgetown, CT; Temple Ohabei Shalom, Brookline, MA; Temple Emanuel
of Baltimore, Baltimore, MD; Congregation Albert, Albuquerque, NM
Allison Grossman: Temple Judea, Tarzana, CA
Elissa Froman: Chicago Sinai Congregation, Chicago, IL
7:00 PM
Shabbat Dinner (Salons A, B, C)
7
7:50 PM
Shabbat Services (Salons H & J)
9:00 PM
Issue Exploration 1: Economic Justice, Faces of Homelessness
National Coalition for the Homeless (Salons H & J)
10:00 PM
Chaperones’ Meeting (Salon D)
10:25 PM
Shuk Program sign up
10:40 PM
Free Time & Snack (Salons A, B, C)
11:00 PM
Eidot, meet with your congregation
11:15 PM
Lailah Tov – All students in their own rooms
Saturday, January 12, 2008
7:30 AM
Boker Tov
8:00 AM
Breakfast (Salons A, B, C)
8:15 AM
Chaperones – find RAC Staff to Discuss Shuk Programs (Salons A, B, C)
8:30 AM
Shabbat Services (Salons H & J)
10:15 AM
Issue Explorations 2 & 3: Campaign Finance Reform and the Assault Weapons Ban,
Kesef, Koach, and Politika: A Lobbying Simulation (Salons H & J)
12:00 PM
Lunch (Salons A, B, C)
1:00 PM
Group 1 to the National Holocaust Memorial Museum
(100 Raoul Wallenberg Place, SW)
1:00 PM
Group 2 to the World War II Memorial and then to National Holocaust Memorial Museum
1:15 PM
Group 3 to the World War II Memorial and then to National Holocaust Memorial Museum
Group 1 leaves Museum for World War II Memorial and then to Georgetown
Group 2 leaves Museum for Georgetown
Group 3 leaves Museum for Georgetown
Dinner in Georgetown
The RAC Staff will be at Paparazzi, 1066 Wisconsin, (202) 298-8000
6:50 PM
Buses leave from the corner of Wisconsin and K Streets to go to Havdalah at the Jefferson
Memorial (weather permitting)
8
7:10 PM
Havdalah Service (Jefferson Memorial)
8:00 PM
Buses leave from Jefferson Memorial to go to hotel
8:30 PM
Program Shuk – choose one program to attend
Issue Exploration 4: Carbon Game (Salon D)
Issue Exploration 5: Give me Health Care, or Give me Death (Salon G)
Issue Exploration 6: I Want to Live in America (Lee)
Issue Exploration 7: Reducing the Rollback of Reproductive Rights (Salon E)
Issue Exploration 8: Tough Choices in International Relations (Salon F)
Issue Exploration 9: With Justice for All: Civil Rights in the Workplace (Jefferson)
9:50 PM
Chaperones’ Meeting (Salon K)
10:00 PM
Free Time & Snack (Salons A, B, C)
10:30 PM
Eidot, meet with your congregation
11:00 PM
Lailah Tov– All students in their own rooms
Sunday, January 13, 2008
7:45 AM
Boker Tov
8:10 AM
Breakfast (Salons A, B, J, K)
8:45 AM
Birkhot Ha-Shachar – Morning Blessings (Salons C & H)
9:15 AM
Issue Exploration 10: Israel and the Peace Process: Loving Israel – Seeking Peace
(Salons C & H)
10:35 AM
Program Shuk – choose one program to attend
Issue Exploration 11: The Energizer Generation (Salon D)
Issue Exploration 12: I Want to Live in America (Salons C & H)
Issue Exploration 13: Save a Life, Save the World: The Global AIDS Crisis in Perspective
(Salon F)
Issue Exploration 14: Reducing the Rollback of Reproductive Rights (Salon E)
Issue Exploration 15: With Justice for All: Civil Rights in the Workplace (Jackson)
Issue Exploration 16: To Teach or to Preach? That is the Question… (Salon G)
12:00 PM
Lunch (Salons A, B, J, K)
12:40 PM
Lobby Prep, Part Ia – How to be an Effective Advocate (Salons C & H)
1:40 PM
Lobby Prep, Part Ib – State Delegation Time
2:30 PM
Depart for Smithsonian National Mall
9
4:40 PM
Depart Smithsonian National Mall for Pentagon Row
5:00 PM
Dinner Pentagon Row, VA
RAC staff will be at Lebanese Taverna, 1101 South Joyce St., (703) 415-8681
6:40 PM
Depart Pentagon Row to hotel
7:00 PM
Lobby Prep, part II – Time to Read Memos
7:30 PM
Lobby Prep, part III – meet with the LAs for the first round of discussions
8:00 PM
Lobby Prep, part IV – write speeches, ask LAs questions
As soon as possible present speeches to LAs, make final corrections
10:45 PM
Lobby Prep Ends
11:15 PM
Lailah Tov– All students in their own rooms
Monday, January 14, 2008
7:45 AM
Boker Tov and Check out
Put all luggage on Bus
8:00 AM
Breakfast (Salons A, B, C)
8:35 AM
Final Lobbying Tips and Preparation (Salons A, B, C)
8:50 AM
Leave for Capitol Hill
10:00 - 1:45
Meetings on the Hill
As a group, decide where you will go for lunch: The Senate Dirksen Cafeteria, the House Longworth Cafeteria,
House Rayburn Cafeteria or the Supreme Court Cafeteria.
2:00 PM
Where To Go From Here? – Wrap up
B318 Rayburn
3: 00 PM
L’hitraot!
This program was made possible through the generosity of:
Bernard and Audre Rapoport
The Jacob and Hilda Blaustein Foundation
The Gus and Barbara Kuhn Fund
The Righteous Persons Foundation
10
Temple Israel Confirmation Class Trip to Washington D.C.
Trip Code of Conduct
I will promote the creation of a religious youth community based on “derech eretz”, mutual
respect, and a sense of personal well-being. I will treat others with “kavod” (honor and respect)
because we are created “b’tzelem Elohim” (in the image of God.)
1. I will not possess, consume, or distribute alcoholic beverages, other than that served by adult
leadership for Jewish sacramental purposes, even if I am of legal drinking age.
2. I will not possess, use, or distribute any illegal drug or drug paraphernalia.
3. I will not smoke, consume, or distribute tobacco products at any time during the trip.
4. I will attend and participate fully in the entire trip, unless otherwise agreed upon with the trip
staff. I will arrive on time, stay until the end, and remain with the group at all times.
5. I will not bring or use any weapons, firearms, or fireworks.
6. I will not commit any illegal act. I understand that vandalism, disturbing the peace, or other
inappropriate behavior as determined by the trip staff will not be tolerated. I understand that
I and/or my family will have to pay for any damage that I cause. I understand that no gambling
is allowed.
7. I will abide by the event curfew determined by the trip staff. After each session or activity I
will go directly to my hotel room and remain there until the next session or activity.
8. I understand that no guests are allowed at any event during the trip, unless permission is
granted, in advance, by the trip staff, and that any unauthorized guests will be asked to leave
immediately.
9. I will not drive to, during, or from the trip.
10. I will not participate in any activities that could be deemed as hazing, sexually harassing,
demeaning or hurtful.
11. I agree to refrain from inappropriate sexual behavior.
12. I agree to abide by any additional rules determined by the trip staff, which may be announced,
and to accept the consequences of the violation of those rules.
13. I understand that I am representing Temple Israel, the Confirmation Class and the
Jewish community and my behavior will reflect that responsibility.
I understand that these rules of behavior and community respect apply from the time I leave
home for the trip, during the trip itself, and until I return home.
(Confirmand AND Parent/Guardian signatures required on Trip Registration Form.)
11
Temple Israel Confirmation Class 5770
Derech Eretz and our Confirmation Community
Derech Eretz: Derech eretz is a Hebrew term which literally means, “the way of the land.” However, the phrase goes far
beyond its literal meaning. Derech eretz means the proper way to conduct ourselves and treat each other, so that we build a
caring and constructive community. When people follow derech eretz, the most amazing and positive things happen in our
world.
As Confirmation Faculty, Students and Parents, we agree to keep the value of derech eretz foremost in our minds as we
together join to create a fantastic Confirmation experience. This requires some agreed upon guidelines, and consideration of
what will happen if the derech eretz in our Confirmation community is lost.
Classes and Courtesy: The Confirmation Faculty promises to make the classes interesting, challenging, fun and engaging.
They promise to treat students with courtesy and respect. Students also should treat the other students, classes, Faculty and
Temple facilities with courtesy and respect. If students ignore requests from the Faculty, or engage in distractions during
class such as having side conversations, doing school homework or using cell phones, pagers or other electronic equipment,
derech eretz is lost.
Attendance: Attendance in class is an essential part of derech eretz, and for students to receive all that they can from the
Confirmation experience. The Confirmation Faculty understands that perfect attendance is an ideal, and that family
emergencies, illnesses, and other commitments sometimes require the student to miss class. Therefore, students may miss no
more than four classes, and make-up assignments will be required for each missed class. Students must attend each of the
Confirmation Service Rehearsals, the Erev Shavuot Consecration Service and dinner, and the Shavuot Confirmation Service.
Lateness/Leaving Early: Just as attendance is essential for Confirmation, being present for the entire session is also
essential. Lateness or leaving early means that a student misses important information, and disrupts the flow of a class. The
Confirmation Faculty understands that occasional lateness or leaving early is sometimes unavoidable. However, repeated
lateness or leaving early destroys our community’s derech eretz. Arrival after 7:15 or leaving before 8:45 will be counted as
an absence.
Leaving Temple Premises: For the safety and security of our students, students must remain in the Temple building after
arrival for class until class is over. Students may not leave the Temple building to go to the surrounding restaurants or shops,
or hang out in the parking lot or around the building.
Drugs, Alcohol, Tobacco & Weapons: The use of these by students is against the law, and is contrary to the derech eretz of
our community.
Class Trip: The class trip to Washington, D.C. will be an amazing experience for our community. There will be special
requirements and expectations for this trip, which will be discussed at the Trip Orientation.
Special Needs: Derech eretz means treating those with special needs with care and respect. Any of the students’ special
needs should be brought to one of the rabbis as soon as possible.
Loss of derech eretz: We all fully expect that all of us will act according to derech eretz. Should any student act in a way
contrary to the derech eretz of our Confirmation community, consequences may include warnings, removal from a particular
class, clergy meetings with parents, parents attending class with their child, or permanent removal from the class and his/her
inability to participate in Confirmation.
Should any derech eretz issues arise that the Faculty does not know about, we invite parents and students to bring these
issues to the Faculty’s attention. We look forward to all of us working together in Confirmation this year.
12
Temple Israel Confirmation Class Trip to Washington D.C.
L’Taken Seminar Trip Registration
Friday, March 5 – Monday, March 8, 2010
REGISTRATION & PAYMENT DEADLINE: Wednesday, December 9, 2009
Refunds: Should you cancel for any reason, you will be refunded for any expenses not incurred at that time.
Airfare is NON-REFUNDABLE and NON-TRANSFERABLE.
COST: $925 per person (Includes seminar program, meals, hotel, bus, admission, airfare and baggage fees for 1 bag)
Scholarships are available. Temple Israel believes that all students should be able to participate in its programs regardless of financial
need. If you have any financial concerns regarding this trip, please speak confidentially with Rabbi Jared Saks at 612- 374-0315 or
[email protected].
Student Name
Gender: male female
Date of Birth
Student Email Address
Student Phone Home
Student Cell
Home Address
City
State
Zip
Weekday school
Congressional District: MN-3, Paulsen MN-5, Ellison
Parent’s Name
Other
E-mail
Parent’s Phone Home
Work
Cell
E-mail
Parent’s Name
Parent’s Phone Home
Work
Cell
Student lives with:
EMERGENCY CONTACTS:
(Temple Israel requires two contacts in the event parents are not available)
1. Name
Relationship
Work
Phone Home
Street & Number
City
State
2. Name
Zip
Relationship
Phone Home
Street & Number
Cell
Work
City
Cell
State
Zip
13
Dietary Restrictions:
None Vegetarian Kosher Other
Food Allergies
Special Medical Information: (allergies, conditions, medications, etc.)
Please provide any additional confidential information of which the trip staff should be aware:
MEDICATION: This person takes medications on a routine basis YES
NO
Please note: This program will require student's mental focus for extended periods of time. It is
strongly recommended that medications taken during the school year used for focusing the teen’s
attention continue through this trip.
List all medications this teen is taking. Please indicate dosage, times, food guidelines and why the teen is taking this medication.
Name of Medication
Dosage/Time & Instructions Reason
The following are over-the-counter medicines the staff may administer to my teen during the course of the trip without first contacting
parents/guardians:
Tylenol (or generic)
Aspirin
Advil (or generic)
Benadryl (or generic)
Sudafed (or generic)
Maalox or other antacid
Insect Repellant
Sun Block
Anti-biotic Ointment/First Aid Cream
Cough Drop/Throat Lozenge
Other
Other
HEALTH INSURANCE *** You must provide a copy of health insurance cardcard- front and back. ***
Carrier or Plan Name
Name of Insured
Employer
Policy #:
Group #
Address
Phone # to verify coverage
Please provide copy of
front
of health insurance card
Please provide copy of
back
of health insurance card
14
Student Name
HEALTH AND SAFETY AUTHORIZATIONS
IMPORTANT–
IMPORTANT–THESE MUST BE COMPLETE FOR ATTENDANCE
Health and Safety:
Safety: — Must be signed by Parent/Guardian
This health history is correct and complete to my knowledge. The person herein described has permission to engage in all program activities except as
noted. I hereby give permission to Temple Israel or the Union for Reform Judaism (URJ) to provide routine health care, administer medications and
seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I
give permission to Temple Israel or the URJ to arrange necessary related transportation for my child. In the event that I cannot be reached in an
emergency, I hereby give permission to the physician/health care provider selected by Temple Israel or the URJ to secure and administer treatment,
including hospitalization, for the person named above. All health care requirements will be at the parent’s or guardian’s own expense.
Signature of Parent/Guardian
Date
Disclosure of Medical Information:
Information: — Must be signed by Parent/Guardian
I understand that Temple Israel or the URJ is not defined as an entity subject to HIPAA and therefore is not covered by HIPAA regulations concerning
patient medical records. I also understand and agree that situations may necessitate that my child’s medical information be shared with the event staff
and/or event medical staff. I give permission to any Health Care Provider, such as a hospital or physician to share my child’s medical information with
the event medical staff, for treatment purposes.
Signature of Parent/Guardian
Date
EVENT PARTICIPATION AUTHORIZATIONS
IMPORTANT–
MPORTANT–THESE MUST BE COMPLETE FOR ATTENDANCE
B’rit Kehillah–Code of Conduct: — To be read and signed by Parent or Guardian
We understand that part of the Confirmation Class Trip experience involves activities, group living arrangements and interactions that may be new to
my child. These things come with certain risks and uncertainties beyond what my child may be used to dealing with at home. I am aware of these risks,
and I am assuming them on behalf of my child. I realize that no environment is risk free and so I have instructed my child on the importance of abiding
by the B’rit Kehillah–Code of Conduct. My child and I both agree that he or she is familiar with these rules and will obey them. We further understand
that sanctions imposed by the adult leadership for violation could include immediate expulsion from the trip, at the expense of the parent or guardian.
Signature of Parent/Guardian
Date
Event transportation: — To be read and signed by Parent or Guardian
I give my permission for my son/daughter to be transported during the trip by authorized vehicle (airplane, bus or automobile.) I agree to indemnify
and hold harmless Temple Israel, the URJ, its employees, volunteers, and members from any harm which may come to my son/daughter while being
transported.
Signature of Parent/Guardian
Date
Photo/Video Release: — To be read and signed by Parent or Guardian
I give my permission to Temple Israel and the URJ to use any video or photograph, either online or in print, or any video taken at the event my child is
attending for the purpose of marketing or promoting Temple Israel or the URJ and its programs.
Signature of Parent/Guardian
Date
B’rit Kehillah–Code of Conduct: — To be read and signed by the STUDENT
I have read the B’rit Kehillah–Code of Conduct and I understand that these rules of behavior apply from the time I leave home for the trip, during the
trip itself, and until I return home after the trip.
Signature of STUDENT
Date
IMPORTANT—
Please notify us if this participant has been exposed to any communicable disease during the three
weeks prior to attendance of this event.
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Temple Israel Confirmation Class Trip to Washington D.C.
Trip Roommate Request
Name _____________________________________________________________
All students will be roomed 4 to a room with two double beds. You may request up to 4
people with whom you would like to room. Rooming assignments will be determined by the
Confirmation staff and will be announced upon check-in to the hotel. No switching will be
allowed. We will do our best to accommodate at least one of your rooming requests. We
would like to remind you that our “Derech Eretz Code of Conduct” places a high value on
treating all member of our class with “kavod”, respect, and inclusivity.
1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________
This form must be returned no later than December 9, 2009.
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September, 2009
To Whom It May Concern:
___________________________ will be participating in Temple Israel’s 10th Grade
Confirmation Class trip to Washington D.C. and will be absent from school on
Friday through Monday, March 5 – 8, 2010. This trip is an important part of the
overall curriculum for Confirmation and includes the study of current legislative
issues and meetings with our local representatives and senators on Capitol Hill. This
experience will no doubt be beneficial to any ongoing studies in social justice, civics
and American studies.
If you have any questions regarding this matter, please contact me or our
Confirmation Coordinator, Wendy Schwartz at 612-374-0344.
Thank you for you support in this matter.
Sincerely,
Rabbi Jared Saks
612-374-0315
[email protected]
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