What We DoIsrael CenterIsrael BoundIsrael Bound ApplicationIsrael Bound Application "*" indicates required fields 12345 NameThis field is for validation purposes and should be left unchanged.Participant InformationName as it appears or will appear on passport* First Middle Last Nickname (if applicable)Date of Birth* MM slash DD slash YYYY Gender*Participant Email*Parents will be CC’d on all emails to participants. Participant Cell Phone*Passport CountryPassport NumberPassport Expiration DateNOTE: Passport must be valid for 6 months past the scheduled return date – July 6, 2026 MM slash DD slash YYYY Passport Pending Yes No Current Grade*Please select from the list below…10th Grade11th Grade12th GradeHigh School*Synagogue Affiliation (if applicable)T-Shirt Size* Small Medium Large XL XXL Passport to Israel Participant?* Yes No Has the participant previously been to Israel?* Yes No Parent/Guardian InformationParent/Guardian 1 Name* First Last Parent/Guardian 1 Email* Parent/Guardian 1 Home PhoneParent/Guardian 1 Cell Phone*Parent/Guardian 1 Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian 2 Name First Last Parent/Guardian 2 Email Parent/Guardian 2 Home PhoneParent/Guardian 2 Cell PhoneParent/Guardian 2 Address Same as Parent/Guardian 1 Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Relationship Status* Married Divorced Separated Widow(er) Single Who does the participant live with?* Both Parents/Guardians Mother Father Other Who should email communications go to?* Both Parents/Guardians Parent/Guardian 1 Parent/Guardian 2 Decision Making Authority: Please indicate which parent is responsible financially for program tuition as well as which parent is legally authorized to make decisions and provide consent on behalf of the participant as pertaining to the Israel Bound trip.* Emergency Contact InformationEmergency Contact Name*This should not be a parent or guardian. First Last Relationship to Applicant*Email* Cell Phone*Home Phone Terms of Acceptance The parent or guardian certifies that the applicant is currently healthy and able to participate in all Israel Bound activities. The parent or guardian grants permission to use pictures in which the participant appears as part of Israel Bound. Jewish Federation of St. Louis reserves the right to adjust the price up to 5% based on exchange rate and airline fuel fee fluctuation. Participants reserve the right to cancel and receive a full refund in the event of a price increase if they so wish. I have read and will understand the terms as outlined on this registration form.Parent/Guardian 1 Signature*Parent/Guardian 2 Signature Payment InformationTrip Dates and Pricing Trip Dates: June 15-July 6, 2026 Trip Price: $8,395* All Inclusive (includes round-trip flight from St. Louis) Note: $3,000 Root One Voucher Available – Price reduced to $5,395 St. Louis teens are eligible for $750 Travel Grant *Including Root One Voucher and Travel Grant, the out of pocket cost comes to $4,645 Payment Schedule A $500 deposit is due with this application that is fully refundable until January 30, 2026. On March 31, 2026, the remaining balance of the trip is due. Passport to Israel, Grants, and Scholarships Passport to Israel funds, grants, and scholarships will be applied prior to the final payment due March 31, 2026. Refunds Refunds requested after the final payment will be reviewed on a case-by-case basis by the Jewish Federation of St. Louis. $500 Deposit Payment Due with Application – fully refundable until 1/30/2026* Check: Make check for $500 payable to the Jewish Federation of St. Louis and mail to Dodi Taylor at 12 Millstone Campus Drive, St. Louis, MO 63146 Credit Card Application Deposit* Price: Credit Card