Discounted Teen Social Justice Journey to Los Angeles

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Register by November 1 to get the deal!

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Discounted Teen Social Justice Journey to Los Angeles

"*" indicates required fields

Name*

First Last

Name of person who referred you to register*

Name as you would like it on name tag*

Gender? Pronouns?

Birthdate*

Grade entering in Fall 2025*

Which school will you attend in Fall 2025?*

Other School Name*

Do you attend part-time Jewish education?

Yes

Name of part-time Jewish school program*

Other Program Name*

Do you/your family belong to a local synagogue?

Yes

Name of Synagogue*

Other Synagogue Name*

Teen's Email*

Home Phone*

Teen's Cell Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

T-shirt Size*

List your top three favorite snacks (brand and type of snack).*

Trader Joe’s snacks are NOT available.

Please specify any dietary needs.*

(kosher, lactose intolerant, vegetarian, gluten-free, vegan, etc.)

Please specify any allergies*

Please specify any relevant medical history (If none, please write N/A.)*

Please specify any emotional/psychological difficulties.*

This information will be kept confidential and will enable our staff to work intelligently and sensitively should any unexpected problem arise.

Please specify any behavioral issues or past traumatic events.*

This information will be kept confidential and will enable our staff to work intelligently and sensitively should any unexpected problem arise.

Applicant Photo*

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Please include a recent clear photo of the applicant.

Parent Information

Parent 1 Name*

Parent 1 Email*

Parent 1 Cell Phone*

Parent 2 Name*

Parent 2 Email*

Parent 2 Cell Phone*

Does the applicant live with both parents?*

Yes

Emergency Contact

Please provide the name and contact information for the person who would be reliably available during the time of the trip.

Emergency Contact Name*

Relationship to Applicant*

Emergency Contact Phone – Day*

Emergency Contact Phone – Evening*

Emergency Contact Phone – Cell*

Health Insurance Company*

ID Number*

Benefits Phone Number*

Health Insurance Card*

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Please upload photos or a scanned image of the front and back of the participant’s health insurance card.

Personal Statements

Please complete the questions below. Statements should be the applicant’s original thoughts. Please limit each statement to 300 words.

When you think about the kind of impact you want to have at school, in the Jewish community or the wider world, how do you see yourself helping to create positive change? And what do you hope to gain from this experience to help you grow and make a difference?*

What does ‘social justice’ mean to you and why is it important in today’s world?*

Are there communities or issues that you are especially interested in exploring?*

How do Jewish values or teachings influence the way you think about justice, equality or caring for others?*

Agreements

Consent

I (We) agree to Tzedek America’s Participation Waiver, Release of Liability, code of Conduct and Medical Authorization Agreement.

TZEDEK AMERICA PARTICIPANT WAIVER, RELEASE OF LIABILITY, CODE OF CONDUCT & MEDICAL AUTHORIZATION AGREEMENT

PROGRAM OVERVIEW
Participation in the Tzedek America program (the “Program”) is a unique opportunity to engage in transformative educational experiences. Our top priorities are safety, respect, inclusion, and responsibility. This agreement outlines expectations, risks, and permissions associated with the Program.
All participants must review and sign this agreement. For minor participants under age 18, a parent or legal guardian must also sign.

CODE OF CONDUCT & RESPONSIBLE USE POLICY
Tzedek America is committed to creating a safe, respectful, and inclusive environment. By participating in the Program, all participants (and their families, when applicable) agree to the following expectations:

Code of Conduct

Respect for Others:Treat all individuals with kindness and dignity. Use respectful language and refrain from discriminatory, hateful, or harassing behavior.
Positive Citizenship: Foster an inclusive and supportive community, both in person and online.
No Bullying: Bullying, including cyberbullying, will not be tolerated.
Respect for Identity: Use and honor each participant’s chosen name and pronouns.
Substance-Free Policy: Use of drugs, alcohol, or vape products is strictly prohibited. Violations may result in immediate dismissal at the participant’s or family’s expense.
Understanding Risk: Acknowledge that some risk is inherent despite precautions.
Cell Phone Policy: Phones should remain in hotel rooms, on the bus, or with staff during programming. Emergency contacts for staff will be provided. Students may use phones for purchases with permission. Participants are encouraged to bring a digital camera or rely on staff photos.
Music Guidelines: Explicit music is not allowed in group settings. Staff may collect Bluetooth speakers if rules are violated.

PHOTO & VIDEO RELEASE
By participating in the Program, the participant (and parent/guardian, if applicable) grants Tzedek America and its partners permission to photograph, film, and use images or recordings of the participant for educational or promotional purposes.
To opt out of media use, please notify Tzedek America in writing prior to the start of the Program.

REFUND & DISMISSAL POLICY
Tzedek America does not provide refunds for voluntary withdrawal or for removal due to behavioral or policy violations. Violations of this agreement may result in immediate dismissal from the Program and further disciplinary or legal action, if necessary.

BEHAVIORAL AGREEMENT
I understand and agree to abide by all expectations outlined in the Code of Conduct and Program policies. I acknowledge that failure to do so may result in disciplinary action or removal from the Program.

PHYSICAL & EMOTIONAL FITNESS
I affirm that I (or my child, if under 18) am physically, emotionally, and mentally capable of participating in all Program activities.

HEALTH SCREENING & COMMUNICABLE ILLNESS ACKNOWLEDGMENT
I affirm that I (or my child, if under 18) am not currently ill, have not tested positive for COVID-19 or other communicable illness in the days preceding the Program, and have not been knowingly exposed to any such illness. I understand and accept the inherent risk of illness despite reasonable precautions.

MEDICAL AUTHORIZATION
In the event of a medical emergency, I authorize Tzedek America staff and medical professionals to:
Provide necessary care, including medication and anesthesia
Conduct diagnostic tests (e.g., X-rays, labs)
Administer treatment, including surgery
Share medical information with emergency responders or insurers
Arrange emergency transportation
If I (or my child’s parent/guardian) cannot be reached, I authorize the attending physician to secure and administer care, including hospitalization. I understand that I am financially responsible for all medical services rendered.

WAIVER, RELEASE OF LIABILITY, & ASSUMPTION OF RISK
Release of Liability
I, the participant (or parent/guardian), on behalf of myself or my minor child and our heirs and legal representatives, release and hold harmless Tzedek America and its affiliates, officers, employees, advisors, agents, and contractors (“Released Parties”) from all liability for injury, illness, property damage, or death in connection with the Program, including claims resulting from negligence.
Indemnification
I agree to indemnify and hold harmless the Released Parties from any claims, demands, or liabilities arising from my (or my child’s) participation in the Program.
Assumption of Risk
I understand and accept the risks inherent in travel, physical activities, group interaction, and other Program components, even when safety precautions are followed.
Severability
If any provision of this agreement is deemed invalid, the remainder shall remain in full force and effect.

TRAVEL & ACTIVITY AUTHORIZATION
I authorize participation in all Program activities, excursions, and local travel organized by Tzedek America, including additional experiences aligned with the Program’s educational goals.

PERSONAL PROPERTY DISCLAIMER
I understand that Tzedek America is not responsible for loss, damage, or theft of personal belongings, including phones, electronics, or other valuables brought to the Program.

TRANSPORTATION & LODGING
I acknowledge that Tzedek America arranges transportation, lodging, and meals with reasonable care and is not responsible for the actions or negligence of third-party providers.

Photo Release and Liability Agreement*

By registering for this event, the participant agrees that their picture and/or video may be taken and potentially used in Jewish Federation marketing material and social media.

Yes, I/(we) agree.

No, I we do not agree.

Terms & Conditions*

TIPPING: Tips for the driver of the coach bus are included in the subsidized study tour price.

INSURANCE: Insurance is not included in the subsidized price.

Here are some providers should you wish to purchase additional insurance, which is highly recommended. Inclusion on this list should not be construed as an endorsement by the Jewish Federation of Greater Pittsburgh.

Travel Guard: www.travelguard.com 800-826-4919
Travel Insurance Services: www.travelinsure.com 800-937-1387
InsureMyTrip: www.insuremytrip.com 800-487-4722

MEDICAL CONDITION: Jewish Federation of Greater Pittsburgh or Tzedek America are not responsible for any medical conditions that may occur during or prior to the tour.

CANCELLATION: All cancellations must be in writing to us and must be sent by the person who made the original reservation. Cancellations are only effective from the day they are received by us. If you cancel your study tour, cancellation fees and penalties will be deducted from your payment. Cancellation fees apply to each person registered.

MINIMUM FEE OF $100.00 PER PERSON FOR ANY CANCELLATION BEFORE September 30, 2025.
PRIOR TO DEPARTURE CANCELLATION FEE:
- From October 1-31, 2025: $250.00 per person
- From November 1-30, 2025: $350.00 per person
- From December 1, 2025 to date of departure: No Refund
*Plus, any penalties applied by airlines, hotels and tour operator.

BAGGAGE: Luggage is the responsibility of the passenger and that of the airlines. For lost luggage claims, the passenger is responsible for notifying the airline directly.

RESPONSIBILITY FOR FLIGHT AND PASSENGER ACCOMMODATIONS AND SERVICES: Jewish Federation of Greater Pittsburgh and Tzedek America are responsible for making all arrangements for tour services offered in the itinerary. The airlines, hotels, land operators and other suppliers providing services are independent contractors and not agents, employees or associates of Jewish Federation of Greater Pittsburgh or Tzedek America. Acceptance and confirmation of your reservation is at the discretion of the airlines even after full payment has been made. Jewish Federation of Greater Pittsburgh and Tzedek America assume no responsibility or liability in connection with the service of an aircraft, motor coach, taxi, or other conveyances, which may be used in the performance of its duty to the passengers. If the tour services as indicated by the itinerary cannot be supplied or there are changes in the itinerary for reasons beyond the control of Jewish Federation of Greater Pittsburgh and Tzedek America, we will arrange for provision of comparable services. Jewish Federation of Greater Pittsburgh and Tzedek America reserve the right to make changes in the itinerary whenever Jewish Federation of Greater Pittsburgh or Tzedek America deem it necessary to the comfort, convenience, and safety of the participant at any time. The participant agrees that Jewish Federation of Greater Pittsburgh nor Tzedek America shall not be liable for any changes in flight schedules, delays, weather conditions, damages, losses (including personal injuries, death and property losses) or expenses occasioned by acts or omissions of any person, including suppliers providing services, or for any acts of war, insurrection, revolts, or other civil uprisings, military actions, strikes, pandemics, or acts of G-d occurring either in the country of origin, through passage or destination. No person other than an authorized representative of Jewish Federation of Greater Pittsburgh or Tzedek America by written consent is authorized to vary, add, or waive any term or condition in this agreement. The right is reserved to decline to accept or retain any study tour passenger should such person’s health or general deportment impede the operation of the tour to the detriment of the other tour passengers.

NOTE: The sequence of activities in the itinerary may change or be reversed; some may be omitted due to circumstances beyond our control.

I/(we) have read and agree to the Terms & Conditions included with this trip.

Name of Teen Agreeing and Consenting*

Name of Parent/Guardian Agreeing and Consenting*

Payment Information

When you submit your application, you will be redirected to a payment form to complete your registration. Thank you.

Phone

This field is for validation purposes and should be left unchanged.

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Your referral just earned you a $100 discount!

Register by November 1 to get the deal!

Enter the name of your friend who invited you so we can thank them, too!

Discounted Teen Social Justice Journey to Los Angeles

Parent Information

Emergency Contact

Personal Statements

Agreements

Payment Information

More Information