Israel Bound Application - Jewish Federation of St. Louis

Name

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

Participant Information

Name 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 Country

Passport Number

Passport Expiration Date

NOTE: Passport must be valid for 6 months past the scheduled return date – July 6, 2026

MM slash DD slash YYYY

Passport Pending

Yes

Current Grade*

High School*

Synagogue Affiliation (if applicable)

T-Shirt Size*

Small

Medium

Large

XXL

Passport to Israel Participant?*

Yes

Has the participant previously been to Israel?*

Yes

Parent/Guardian Information

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Email*

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Email

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Address

Same as Parent/Guardian 1

Street Address Address Line 2 City 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 Information

Emergency 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 Information

Trip 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