Aish Destiny Jewish Family Experience Application 2020

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Family Information

Family Name

Please select your Jewish affiliation

Organizational Affiliation

Number of Family Members Attending the Mission

Contact Information

Primary E-mail Address

This address will be used for all official communication about the trip.

Address Line 1

Address Line 2

City

State

Zip Code

Country

Individual Profile

Basic Information

First Name

Last Name

Gender

Date of Birth

Cell Phone

E-mail Address

Current Employer

Job Title

Passport Information

To travel on a passport, it must be valid for at least 6 months AFTER your return date. If you are waiting for your passport you may write "pending", and enter today's date for the expiration date. Please email your passport information to Destiny@aish.com as soon as you have it.

Name as it appears on passport

Country of Citizenship

Passport Number

Exp.Date

Some Details To Ensure A Successful Trip

Does this person have accessibility needs or physical limitations?

Please describe the accessibility requirements and/or physical limitations in detail.

Does this person have any special dietary requirements or allergies?

Please describe the special dietary requirements and allergies in detail.

Is this person currently receiving any medical treatment?

Please describe the medical treatments in detail.

Has this person been hospitalized or had surgery in the past year?

Please describe the hospitalization/surgery in detail.

Is this person currently taking any medications regularly?

Please describe the medication regiment in detail.

Terms and Conditions

I hereby release Aish HaTorah, 580014363 (“YAT”) and/or any representative on its behalf from any legal liability and/or any loss or damage which I may sustain, personally and/or to my personal possessions, in connection with my participation on the tour that will tack place on the Aish Destiny Family Experience (the "Tour"). I hereby declare, as follows;

I have consulted a physician of my own choice who confirmed my participation in the Tour as defined above.

I am aware that any change in my medical condition requires a renewed medical approval, and that any such change requires me to immediately notify Aish.

I acknowledge that the Tour activities, including, but not limited to, hiking, rafting, snorkeling, swimming, camping, bus, jeep, and air travel, may be subject to certain hazards (the "Tour activities").

I hereby declare that I am voluntarily participating in the Tour and Tour activities, and I hereby agree to accept any and all risks associated with my participation therein.

I acknowledge that the medical insurance secured by YAT for during the Tour does not cover pre-existing conditions and that I am advised to cover the risks associated with the Tour and Tour activities by personal insurance.

I hereby release YAT and/or any representative on its behalf from any legal liability arising from the Tour and/or the Tour activities and undertake that I will not raise any such claims or complaint against YAT and/or any representative on its behalf, and I hereby waive any and all claims against YAT as to its liability for any damage as a direct or indirect of Tour and/or the Tour activities, including but not limited to personal possessions damages and/or equipment loss.

I hereby agree and give my irrevocable permission that Aish and/or any representative on its behalf may use photographs which I appear in, in the course of the activity, for advertising and public relations purposes in any existing or future broadcast media. (press, television, internet, cellular and / or any other media) without any consideration.

By submitting my online application, I declare, that I have read a fully understood this agreement and agree to be bound by its terms and conditions.

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