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About
Our Story
Our Team
Programs
Zisel’s Links
Shlomie’s Club
Little Pearls
Legally Links
Resources
Contact
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5787 SC Shabbos Yerushalayim
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Name of bachur joining the Shabbaton
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DOB
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Bachur's cell
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Can we text the number above?
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Yeshiva name
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Yeshiva location
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Name of Rosh Yeshiva
(Required)
Which parent(s) passed away?
(Required)
Mother
Father
Both
How long ago was your mother niftar?
(Required)
0-6 months
7-11 months
1-3 years
4-6 years
7-10 years
11-15 years
16+ years
How long ago was your father niftar?
(Required)
0-6 months
7-11 months
1-3 years
4-6 years
7-10 years
11-15 years
16+ years
Do you have yahrtzeit over Shabbos?
(Required)
Yes
No
Do you have any allergies?
(Required)
Yes
No
Please specify which food you're allergic to and your reaction when exposed
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Will you be bringing an EpiPen
(Required)
Yes
No, I don't need one
Do you have a medical or mental health condition we should know about?
(Required)
Yes
No
Please specify
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Which of the following topics would you be interested in exploring at the Shabbaton? (Check as many as apply)
(Required)
Concern about siblings
Delayed grief
Emunah & bitachon
Losing a mother
Losing a father
Remarriage/blended families
Shidduchim
Sudden loss
Therapy
Other (please specify)
Is there a different topic you'd like to explore?
Any questions you'd like Rabbi YM Katz to address at the Q&A session?
Do you have sisters 9th grade-23 who would want an invite to our girls Shabbaton?
(Required)
Yes
No
Do you have brothers 14-24 who would want an invite to our boys Shabbaton in the US?
(Required)
Yes
No
For the benefit of all, our policy is that no alcohol may be brought in. (Alcohol includes wine and any and every other beverage containing alcohol.)
(Required)
I agree
Will you be participating in the full program, beginning Friday at 9:30 a.m. at the meeting place, until after the melaveh malkah on Motzoei Shabbos (ending approx. 10:30 pm)?
(Required)
Yes, I'm so excited to join the full program
I will not be able to join the Friday trip
If you are not joining the Friday trip, you must be at the Shabbaton location (in the Old City) no later than 2:30 p.m.
(Required)
Yes, I will be there by 2:30 p.m.
We love seeing everyone! However, it takes a lot of time and effort to pull this event together. Therefore, if you cancel less than 48 hours prior to the event for any reason other than being sick, we'll be forced to charge the credit card provided below $100.
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I agree
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