Gesher NYC Trip 2025

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Temple Anshe Hesed - Gesher NYC Trip Registration 2025

The dates for this year's trip are April 24th - 27th. Cost per student is $450.

Please sign into your Temple Account before completing the online registration. If you need assistance with this, please contact the Temple office at 814-454-2426.

Family Name

STUDENT INFORMATION

How many students are being registered?

STUDENT 1 INFORMATION

Student 1

Student 1 - Name

Student 1 - Date of Birth

Student 1 - Secular Grade

Student 1 - Secular School

Student 1 - Preferred Pronoun

(i.e. he, him, his, she, her, hers, they, them, theirs)

Student 1 - Allergies

Student 1 - Health Concerns

Student 1 - Special Needs

STUDENT 2 INFORMATION

Student 2

Student 2 - Name

Student 2 - Date of Birth

Student 2 - Secular Grade

Student 2 - Secular School

Student 2 - Preferred Pronoun

(i.e. he, him, his, she, her, hers, they, them, theirs)

Student 2 - Allergies

Student 2 - Health Concerns

Student 2 - Special Needs

PARENT INFORMATION

* Parent/Guardian 1 - First Name

* Parent/Guardian 1 - Last Name

* Parent/Guardian 1 - Email Address

* Parent/Guardian 1 - Cell Phone

* Parent/Guardian 1 - Address

* Parent/Guardian 1 - City

* Parent/Guardian 1 - State

* Parent/Guardian 1 - Zip Code

Parent/Guardian 1 - Home Phone

Is there a second Parent/Guardian?

* Parent/Guardian 2 - First Name

* Parent/Guardian 2 - Last Name

* Parent/Guardian 2 - Email Address

* Parent/Guardian 2 - Cell Phone

Does parent/Guardian 2 live at the same address as Parent/Guardian 1?

Parent/Guardian 2 - Address

Parent/Guardian 2 - City

Parent/Guardian 2 - State

Parent/Guardian 2 - Zip Code

Parent/Guardian 2 - Home Phone

MEDICAL INFORMATION

Physician Name:

Phone Number:

Insurance Company:

Policy / ID#:

EMERGENCY CONTACT INFORMATION

Please list two persons other than parents that can be contacted in the event of an emergency.

* Emergency Contact 1 - Name

* Emergency Contact 1 - Phone Number

* Emergency Contact 1 - Relationship to Student

Emergency Contact 1 - My child(ren) may be released to this person.

* Emergency Contact 2 - Name

* Emergency Contact 2 - Phone Number

* Emergency Contact 2 - Relationship to Student

Emergency Contact 2 - My child(ren) may be released to this person.

RELEASE INFORMATION

* Please check to confirm all boxes below:

Press Release: I grant the Gesher Program of Temple Anshe Hesed permission to take photographs / videos of my child(ren) in connection with Gesher School events. I agree that Temple Anshe Hesed Gesher Program may use this consent for such purposes as newsMedical Release: In the event of a medical emergency or injury, I authorize Temple Anshe Hesed to administer First Aid and/or transport for my child(ren)Activities Release: I authorize my child to participate in any trip activity, including added stops not on the itinerary without prior notice. I also release Temple Anshe Hesed to transport my child(ren) to the destination, all activities and home.

Copy of ID (Passport if available) and Copy of Medical Insurance Card.

Please submit copies of your child's ID (their passport if available) and a copy of their medical insurance card.

Total Fees

Tue, March 11 2025 11 Adar 5785