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General Wait List
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General Wait List
General Wait List
"
*
" indicates required fields
Name of Program/Event
*
Name
*
First
Last
Email
*
Phone
*
Zip Code
*
ZIP Code
Which of the following best describes your current life stage (please check all that apply):
Adult 21-39 years old
Adult 40-55 years old
Adult 55+
Parent of Young Children (0-9)
Parent of Tweens (10-13)
Parent of Older Children (14-21)
Empty Nester
Grandparent
Retiree
Other
Total Number of People to Join Wait List (including yourself)
*
1
2
3
4
5
Additional Participant #1
Name
*
First
Last
Is this person under 18 years old?
*
Yes
No
Date of Birth
*
MM slash DD slash YYYY
Email
How is this person related to you?
*
Spouse
Child
Grandchild
Other Relative
Friend
Additional Participant #2
Name
*
First
Last
Is this person under 18 years old?
*
Yes
No
Date of Birth
*
MM slash DD slash YYYY
Email
How is this person related to you?
*
Spouse
Child
Grandchild
Other Relative
Friend
Additional Participant #3
Name
*
First
Last
Is this person under 18 years old?
*
Yes
No
Date of Birth
*
MM slash DD slash YYYY
Email
How is this person related to you?
*
Spouse
Child
Grandchild
Other Relative
Friend
Additional Participant #4
Name
*
First
Last
Is this person under 18 years old?
*
Yes
No
Date of Birth
*
MM slash DD slash YYYY
Email
How is this person related to you?
*
Spouse
Child
Grandchild
Other Relative
Friend
Untitled Survey Field
I like activities like this
Someone encouraged me to participate
This activity aligns with my values
Rising antisemitism makes me want to participate in activities like this
The war in Israel makes me want to participate in activities like this
Does anyone attending this event have any food allergies?
*
Yes
No
If yes, please specify the allergy and severity of allergy (ex. if it is an airborn allergy):
Does anyone attending this event need any special accommodations?
*
Yes
No
If yes, please specify:
Photo Permission
*
I give my permission to have my photograph used by The Associated Jewish Federation of Baltimore and its agencies. My agreement on this form gives photography release rights to The Associated Jewish Federation of Baltimore and its agencies. This release pertains to print as well as electronic media, including brochures, advertisements, annual reports, the website and other materials used to promote The Associated Jewish Federation of Baltimore and its agencies and constituent agency programs to the community. This release excludes third party media, state, and corporate security from the waiver.
Yes
No
Liability Release (for all participants)
*
I release and hold harmless THE ASSOCIATED: Jewish Federation of Baltimore, its affiliates, officers, employees and agents from and against all claims, damages, liabilities, losses and expenses actually incurred, arising out of any personal injury or property damage resulting from participation in any activity. This release shall be binding on my family, heirs, executors, administrators, personal representatives and guardians.
Yes
No
Liability Release (for participants under 18)
I represent that I am the custodial parent or legal guardian of the above registered child(ren), and intend THE ASSOCIATED and its affiliates, officers, employees and agents rely on this representation.
I Agree
N/A -- I am not the legal guardian of the registered child(ren)