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Civil Rights Trip to Atlanta

We are looking forward to our trip to Atlanta on Thursday May 19th-Sunday, May 22nd.

The trip is being generously subsidized by Lisa Keller and Saky Yakas. The cost includes airfare, hotel, transportation in Atlanta, and food. Please register on or before Monday, February 14th.

Trip participants must also attend the preparatory sessions prior to the trip.
 
Contact Rebecca at relkusferst@tinr.org with questions.



A 3% administrative fee will be added if you choose to pay by credit card.

Fee $645.00
Please click that you understand that payment is non-refundable after February 25th.

Parent Information

Emergency Contact Information if we can't reach a Parent or Guardian

Medical Information


Immunization Record & Community Brit (Behavior Contract)

I understand that we will need to submit all forms in order for registration to be complete.

Authorizations

The teen listed above has my permission to engage in all Temple Israel of New Rochelle (TINR) programming activities on the Civil Rights trip.

In the event that I cannot be reached in an emergency, I hereby give permission to TINR to seek emergency medical treatment and arrange necessary related transportation for my child. I hereby give permission to the physician/health care provider selected by TINR to secure and administer treatment, including hospitalization, for the person named above.




Please make sure the registration form is completed in its entirety and click "register."

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