Young Judaea
Pittsburgh Shabbaton
Miss camp, never been to camp, want to see old friends, want to meet new friends?
Don't miss out on our Young Judaea Pittsburgh Shabbaton.
The Shabbaton is open to all children from 2-12 grade in the Pittsburgh, Ohio, Michigan, Maryland/DC area... basically, if you can get here, you are welcome!
When:
February 28th, 5:30PM arrival to March 1st, 7:30PM pick-up
We want everyone to feel like they can participate in the Shabbaton but recognize that some people may have other obligations, if your child can only participate for a portion, let us know. We’d rather have them join us for some of it if they can’t join for all of it.
Where:
Beth El Synagogue, 1900 Cochran Rd Pittsburgh, PA 15220
Cost:
This year,
we are doing a pay-what-you-can system. The estimated cost is $108/person.
For questions about the Shabbaton, please contact Evan Ressel at evan.ressel@youngjudaea.org.
To complete this form, you will need:
Registering participant's and parent's contact information
Registering participants dietary restrictions, insurance information (including a copy of insurance card), and an emergency contact
Participant Registration Information
Participant First Name
Participant Last Name
Participant Birthdate
Current Grade:
Please select...
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Freshman (9th Grade)
Sophomore (10th Grade)
Junior (11th Grade)
Senior (12th Grade)
Participant Pronouns
Participant Email
Participant Cell Phone
Participant Mailing Address
Street Address
Apt. Number (If applicable)
City/ Town
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
For out-of-town families, if you’re not returning home on Saturday night does your child or children need a place to stay on Saturday night? We will do our best to organize homes for them to sleep at.
Yes I'm interested in getting contacted about organizing a place for my child to stay
Which summer camps did you attend? (Please select all that apply)
CYJ Sprout Lake
CYJ Midwest
CYJ Texas
Camp Judaea
Tel Yehudah
Did not attend
Were you referred by someone? Please list their name below:
Parent Information and Photo and Video Consent
Parent First Name
Parent Last Name
Parent Email
Parent Cell Number
Choose if you do/do not give Young Judaea permission to use photos and videos of your child in promotional materials:
Yes, I give permission for Young Judaea to use photos and videos of my child in promotional materials
No, I do NOT give permission for Young Judaea to use photos and videos of my child in promotional materials
Parent Full Name
Date
Health and Medical Form
Dietary Restrictions?
None
Vegetarian
Vegan
Pescatarian
Dairy Free
Gluten Free
Other
Note: Some dairy food will be provided by local restaurants that are not Hechsher Kosher.
Please describe your dietary restrictions:
Please list all allergies, including any allergies to food and/ or medicine:
Please list all medications the participant is currently taking, which medications they will be bringing to Shabbaton, and any instructions related to dosages and times the participant should be taking their medications:
Health Insurance Provider:
Policy/ Group Number
Please upload an image of the FRONT of your health insurance card.
Please upload an image of the BACK of your health insurance card
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Relationship to Participant
Emergency Contact Cell Phone
Emergency Contact Email
Consent, Release and Indemnification
Please Read and Acknowledge
The Parent/guardian signing below (“Parent”) hereby consents and gives permission to participate in
Young Judaea Pittsburgh Shabbaton
the “Event” which term shall include all times and all activities during or related to the Event, travel to, from and during or related to the Event, and early dismissal, expulsion or other removal, if any, from the Event) on or about the following date(s):
February 28th, 2025 to March 1st, 2025
and any date(s) to which such Event may be postponed or rescheduled. Parent and Child each agree that Child will observe and be bound by all policies, terms, conditions, rules and regulations and restrictions (including, without limitation, rules related to discipline and drug and alcohol use), whether written or unwritten, of the Event or Young Judaea (the “Program Terms”), including any such Program Terms as may be changed, modified, or newly established at any time, including after this Consent, Release and Indemnification is signed.
Click here
to read the full Consent, Release and Indemnification agreement.
Young Judaea Event Rules of Good Conduct
The following rules and restrictions are in place to provide for the health, safety, and welfare of all participants at the Young Judaea Event. During the Event, Young Judaea may find it necessary to alter and/or add rules and restrictions. Participants agree to fully comply with all Event rules and restrictions including any alterations and/or additions made by Young Judaea. All Event rules apply throughout the entirety of the Event including during free time. Any failure to comply with Young Judaea’s rules and restrictions and any alterations and/or additions thereto may result in disciplinary measures as set forth in these Rules of Good Conduct, in the sole discretion of Young Judaea, up to and including immediate dismissal and/or other removal from the Event. The following Event rules are not exclusive and the failure to specify in each rule that violation may result in dismissal or other removal from the Event shall not preclude Young Judaea from doing so in its sole discretion. Further, the failure of Young Judaea at any time to enforce any rule or restriction or to exercise any right with respect to disciplinary action, will not be construed as a waiver of any such right, will not affect any subsequent violation, and will not prejudice Young Judaea in connection with any subsequent enforcement or disciplinary action.
Participants and parents/guardians have read, understand, and agree to follow these policies.
1. All participants have read, understand and agree to follow the Young Judaea Tobacco, Drug and Alcohol Policy (the “Drug and Alcohol Policy”) set forth above as part of this Consent, Release and Indemnification. Any participant found to be in violation of the Drug and Alcohol Policy understands that he/she will be disciplined in accordance with the Drug and Alcohol Policy.
2. In order to provide an atmosphere which is comfortable for everyone, Kashrut will be observed.
3. No one may leave the Event grounds (as such grounds are defined by the Event manager in their sole discretion) without specific permission of the Event manager.
4. All participants must obey the staff members at all times. Participants must respect each other and all other people they come into contact with during the Event and refrain from inappropriate behavior.
5. All participants must respect the property of each other and of the Event site.
6. All participants will attend and participate in the entire Event, including all of its scheduled activities, unless otherwise informed by the staff, it being understood that physical sports are always optional.
7. Young Judaea reserves the right to search the property and/or accommodations of any participant including accommodations not owned and/or operated by Young Judaea, with or without the presence of the participant.
8. Participants are not permitted to possess knives or other weapons of any kind.
9. Participants are jointly responsible with their parent(s)/guardian(s) for any damage, including graffiti, to the physical facilities used for the Event and parent(s)/guardian(s) will be billed to cover the cost of the repair.
10. Participants disrupting the group, not adhering to Event rules and policies and/or not participating in mandatory Event activities, as determined in the sole discretion of the Young Judaea staff, will result in disciplinary action and/or dismissal.
11. Participants will be advised of further rules which govern the Event, and by which each participant agrees to be bound, at the start of and throughout the Event.
Any participant who is dismissed or otherwise removed from the Event, will be sent home at their own expense. The participant and their parent/guardian are responsible for the cost of returning them home, including the return fare, shipping of baggage, any other associated expenses, and for any and all damages arising out of the involvement of the participant and/or the participant’s actions. The above also applies to any participant who voluntarily removes themselves from the program.
In all cases of discipline, dismissal and/or other removal, the determination of Young Judaea regarding the Event rules, restrictions, and policies and their application shall be final and not subject to challenge in any forum. In addition, Young Judaea reserves the right to contact the local authorities. Any violation of law by or involving a participant will be subject to the penalty, laws and rules imposed by the local jurisdiction, and Young Judaea will not undertake to provide participant with legal assistance.
As the parent of the registering participant, I confirm that I have read and understand
Young Judaea's Consent, Release and Indemnification Policies
As the registering participant, I confirm that I have read and understand
Young Judaea's Consent, Release and Indemnification Policies
Payment Information
Adults are invited to join us for Havdallah and Rikud on Saturday night. Please indicate below if you and any additional adults would like to attend:
Yes I will attend
No I will not attend
How many other people will be joining you?
Please select...
0
1
2
3
4
This year, we are doing pay-what-you-can for our Shabbaton. The estimated cost is $108/person.
How much would you like to contribute?
$210
$150
$108
$85
$60
$40
$25
$10
$0
Other
You will need to complete the form separately for each participant but may process payment once for all participants in a single checkout.
Other Amount
Payment Information
Contribution Amount
Name on Card
Billing Email
Card Number
MM
YY
Code
Contact Information