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Retreat Application

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Personal Information

Name*
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Email Address*
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Permanent Contact Information

Residence of*

Address*

Family Background

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General Education History

Jewish Education History

Which Jewish schools (if any) did you attend?
What Jewish education have you had?*
How would you describe your Jewish affiliation?*
How would you characterize your Jewish observance?*
What is your attitude towards marriage?*

Previous Israel Travel History

Have you ever been to Israel?*
Have you ever been on Birthright?*

Special and Medical Requirements

Do you have any dietary requirements?*
Have you ever taken medication for any aspects of your health?*
Have you ever been hospitalized?*
Do you have any accessibility requirements or physical limitations or restrictions?*

References

Please do not include family or friends.

Waiver*
By checking this box and electronically signing below, I acknowledge that I have read and agree to the terms and conditions of the Heritage Retreats Trip Waiver Agreement. View waiver here: https://heritageretreats.com/wp-content/uploads/2017/11/HeritageRetreatsTripWaiverAgreement.docx-2-1.pdf
Olami Consent*
With programs in over 30 countries, Olami and its funding partners sometimes use independent verification firms to assure that programs are attended and impactful. By registering, I understand that I might be contacted by a verification firm for quality control purposes.
Olami is funded in part by Mosaic United. Please let us know if you would like to be contacted regarding future Mosaic sponsored-opportunities.
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Useful Links

Men’s Retreat

Heritage Poland

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Contact Us

557 Fenlon Blvd.,
Clifton, NJ 07014
Tel: U.S. 800-927-0476
Canada: 866-268-7169
Fax 603-250-2965
info@heritageretreats.com