Tzelem Group Registration

"*" indicates required fields

Name of person completing this form*

First Last

Relationship to Participant*

Email*

Name of participant*

First Last

Preferred Name

Pronouns

Birthdate*

Participant's Cell Phone*

Participant's Email*

Name of School*

Grade in current school year*

Participant's Address*

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

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Untitled

Please list any/all participant dietary restrictions and/or food allergies.*

Does the participant need any specific accommodations?*

Yes, the participant needs specific accommodations.

No, the participant does not need any specific accommodations.

Please specify the requested accommodations.*

Please enter two emergency contacts.

Emergency Contact 1 Name*

First Last

Relationship to Participant*

Emergency Contact 1 Cell Phone*

Emergency Contact 2 Name*

First Last

Relationship to Participant*

Emergency Contact 2 Cell Phone*

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

Name

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