Main Parent/Guardian Contact Information

This email address is:

PersonalWorkAlternate

Email(s) for Correspondence (one per line)

HINT: List any email(s) (including yours) where you would like to receive our regular communication

State

ZIP Code

Will at least one parent/guardian be able to attend our fall camping trip? (Friday, October 25 – Sunday, October 27)

YesNo

Youth Information

MM/DD/YYYY

Child’s Grade Fall 2023

Is this your child’s first Wilderness Torah program?

YesNo

Financial Aid

Do you need to apply for financial aid?

YesNo

Do you want to request an installment plan?

YesNo

Physical & Mental Health

The B'naiture program can be challenging both physically and psychologically. As mentors, it is very important for us to know how to best support the participants. For that reason we ask about physical and mental health.

Describe any food or medical allergies, including medications your child is taking:

Please include symptoms to look out for, medication dosages, and when to administer them (time of day, etc.).

Describe any medical issues, including current medications your child is taking:

Please include symptoms to look out for, medication dosages, and when to administer them (time of day, etc.).

Describe any mental health issues (current or from the last 3 years), including treatment and/or medications your child is taking:

Please include symptoms to look out for, medication dosages, and when to administer them (time of day, etc.).

Has your child sustained any major injuries or undergone hospitalization in the last year?

YesNo

Please describe in detail:

Please describe any behavioral issues, challenges, or other special circumstances we should know about that might affect your child’s experience:

If there is anything else you think we need to know, please share:

Program Questions for Parent to Answer

What do you hope your child will gain through participation in B’naiture?

Please briefly describe your child’s relationship to Judaism in the context of your family. If your child and family have a relationship with another religion/spiritual path, please share that here.

Please briefly describe your child’s relationship to nature.

What personal gifts might your child bring to B’naiture?

What challenges might your child have in B’naiture?

How would you describe where your child is in their transition from childhood into adolescence?

Does your child have any significant challenges at school or home that we should know about?

If there is anything else you would like to tell us about you, your family, and/or your child, please share:

Program Questions for Youth to Answer

At B’naiture we spend our days having fun and exploring outdoors. This means being in an environment full of natural mysteries and adventures waiting to happen — and often involves getting wet or dirty and trying new things.

How do you feel about encountering challenges at B'naiture?

Kids of many Jewish and multi-faith backgrounds are welcome at B’naiture. Some are raised with a lot of Jewish practice in their homes and are having a Bar/Bat Mitzvah, and others have never learned anything about Judaism before.

What is your relationship to Judaism?

What do you think are your main strengths that you will bring to B'naiture?

What do you think is a challenge that you may face at B'naiture?

What is your favorite plant or animal and why?

Do you have any questions for us, the B’naiture mentors?