Student Retreat Registration

Parent/Guardian Info
Parent/Guardian Info
Parent/Guardian 1 Name

First NameLast Name
Parent/Guardian 1 Preferred Email
example@example.com
Parent/Guardian 1 Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Preferred Email
example@example.com
Parent/Guardian 2 Preferred Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
My second parent/guardian has...
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If the cost of this retreat presents a financial hardship, email Jess for a possible accommodation, at jnevins@berkeleyhillel.org

Retreat Registration

This retreat is heavily subsidized by the generous support of the Colen Family.

$50.00 Quantity

Total

Student Info