New Orleans Registration

New Orleans Service Trip - Registration Form
Student Name*

First NameLast Name
Parent Name*

First NameLast Name
Is parent interested in chaperoning?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Student Mobile Number*
Parent E-mail*
example@example.com
Parent Mobile Number*
Student Birth Date*

MonthDayYear
Grade*
School*
Temple Affiliation (if applicable)
Dietary restrictions
Payment
While the final cost will depend on the exact flight rates annd number of participants, we expect it to be around $750 per student and $500 per adult chaperon, after significant subsidy from J-LOFT. This price includes flights, accomodation, meals and trasnportation during the trip.

To reserve your spot on the service trip, we ask for a $250 deposit per participant, which is refundable in case of the trip does not taking place, for any reason.
Pay Deposit*
prevnext( X )
Service Trip Deposit
$250.00 Quantity

Total

$0.00
Comments/Questions
Should be Empty:

New Orleans Service Trip - Registration Form