TEMPLE SHIR TIKVA

6th Grade Shabbaton

Friday, January 31, 2025 • 2 Sh'vat 5785

3:00 PM - 1:00 PM 1 day afterURJ Eisner Camp

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	* Parent/Guardian 1 Email * Parent/Guardian 2 Email * First Name of 6th Grade Participant * Last Name of 6th Grade Participant * Emergency Contact 1: Name, Cell #, Relationship to Student * Emergency Contact 2: Name, Cell #, Relationship to Student * Please list all medications your student takes regularly and will bring with them on the Shabbaton: Include the name, time of day they take it, and dosage. Even if your student typically self-administers their medication at home, all medications will be administered by an adult chaperone on the Shabbaton. * By writing my name below, I give permission to the Shabbaton adult leadership to administer Over The Counter medications to my child as deemed necessary. Please list any Over The Counter medications my student should NOT be given. Please check off any food allergies/dietary restrictions your student has: Gluten-FreeGluten-Free - CeliacDairy-Free/Lactose IntolerantEgg-FreeVeganTree Nut AllergyPeanut AllergySesame AllergyOther (List Below) If you selected 'Other' above, please list the food allergies/dietary restrictions your student has that were not listed: Please select UP TO 3 other students who you would like to request for your student to room with on the Shabbaton. We will do our best to honor at least one of your student's requests. What is a fun fact about your student? We may use this in a community-building game during the weekend of the Shabbaton! Is there anything else we should know about your student in advance of the Shabbaton weekend?
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Thu, January 30 2025
1 Sh'vat 5785

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Thu, January 30 2025 1 Sh'vat 5785

Temple Shir Tikva | 141 Boston Post Road, Wayland MA 01778 | 508-358-9992

THE HEART OF JEWISH LIVING AND PRACTICE IN METROWEST BOSTON

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