Vanderbilt Hillel · FYSH Fest Pre-Orientation Program 2019

Student Participant's Information

Student participant's name

*

First Name

Last Name

Student participant's home address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Student's mobile phone

*

Non-Vanderbilt Email

*

Verify Email

*

What is your anticipated graduation year?

*

Student's birthday

*

(mm/dd/yyyy)

Student participant's T-shirt size

*

Have you participated in any Jewish youth groups?

Please select all that apply.

BBYO

NIFTY

USY

Other

What programs, groups, or topics are you MOST excited about learning about?

Please select all that apply.

Dore's for Israel

Community Service

Challah for Hunger

Fantasy Football

Spring Break International Service Trip

Birthright

Greek Life

Shabbat Services and Dinner

High Holidays

Which options best describe your diet?

Please check all that apply.

Vegan

Vegetarian

Pescatarian

Gluten Free

No Red Meat

Dairy Free

Kosher Style

Glat Kosher

Do you have any common dangerous food allergies we should be aware of?

Please select all that apply. Do not include food preferences, just serious allergies.

Gluten

Dairy Products

Tree Nuts

Strawberries

Soy

Peanuts

Other

Please tell us about the severity of the allergies you selected or additional allergies.

Please include severity of the reaction and required treatment.

Please tell us about any physical restrictions, injuries, or conditions that may require special accommodations.

Activities for the program include walking and minor physical icebreakers or games.

Family Information

How many adult (21+) family members will be escorting the student participant?

*

We will have programming for families! In addition to providing emergency contact information for the student, tell us who else is coming.

How many (younger / under 21) siblings of friends are coming in addition to the student participant?

*

We will have programming for families! In addition to providing emergency contact information for the student, tell us who else is coming.

Primary family / parent contact for student participant

*

First Name

Last Name

Relationship to the student participant

*

Mobile phone

*

Email address

*

Verify Email

*

Does the primary family / parent contact live at the same address as the student participant?

*

Yes

No

Primary contact's home address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Additional Family Members

Second family / parent contact for student participant

First Name

Last Name

Relationship to the student participant

Mobile phone

Email address

Verify Email

Does the secondary family / parent contact live at the same address as the student participant?

*

Yes

No

Secondary contact's home address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country