Passport to Israel – New Enrollee

Fill out the form below to enroll in the Passport to Israel program.

Student Name*
First Last
Grade (2021-2022 school year)*
Birth Date*
MM slash DD slash YYYY
Gender
Parent/Guardian 1 Name*
First Last
Parent/Guardian 1 Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian 1 Phone*
Parent/Guardian 1 Email*
Parent/Guardian 1 Synagogue Affiliation (if applicable)
Parent/Guardian 2 Name
First Last
Does Parent/Guardian 2 have a different address?
Parent/Guardian 2 Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian 2 Phone
Parent/Guardian 2 Email
Parent/Guardian 2 Synagogue Affiliation (if applicable)
How would you like to make your first contribution?*
- Check: Make check payable to the Jewish Federation of St. Louis and mail to Jody Gerth at 12 Millstone Campus Drive, St. Louis, MO 63146
- Credit Card
Synagogue*
Synagogue*
Billing Address*
Same as Parent/Guardian 1

Street Address Address Line 2 City State ZIP Code
Credit Card*

Discover
MasterCard
Visa
Supported Credit Cards: Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
Agreement*
- I agree to contribute a combined total of $200 each year to a Passport to Israel account funded by the Jewish Federation of St. Louis and administered by the Jewish Federation of St. Louis (JFed). The Jewish Federation will contribute $200 per student for each enrollment year between 3rd and 10th grade. These funds will be available for use on an approved Israel experience upon the conclusion of 9th grade through age 26. The terms and rules for participation in the program are defined on the Passport to Israel page. The parties to this agreement state they have read the Passport to Israel page and have agreed to participate in the program according to its terms.
Signature*

A typed signature is considered legally binding.
Phone
This field is for validation purposes and should be left unchanged.

Checks should be made payable to Jewish Federation of St. Louis for the participant contribution. Please mail check to:

Karen Rader
Jewish Federation of St. Louis
12 Millstone Campus Drive
St. Louis, Missouri 63146

If you are not sure if your congregation contributes to the matching funds or if you have any questions, please contact Karen Rader at KRader@JFedSTL.org or 314-442-3756.

Passport to Israel – New Enrollee

Community Leadership & Engagement