Participant Information

First Name

Last Name

Birth Date

Current Grade *

Current School

Cell Phone (if applicable)

Household / Adult Primary Contact

Name of person completing this form *

Father First Name *

Father Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Home Phone

Cell Phone

Email Address *

Mother First Name *

Mother Last Name *

Check if contact info is same as above

Address 1

Address 2

City

State

Zip

Home Phone

Cell Phone

Email Address *

Weekend Details

My son will be flying and will need transportation to and from the airport *

Yes

No

My son will be flying as an unaccompanied minor. *

Yes

No

We live locally and my son would like to: *

Sleep at home.

Sleep in the TTI dorm on Friday night.

If you have your son's flight information, please fill it in below. If you do not have that information yet, please e-mail it to sbroderick@texastorah.org as soon as possible.

Airport

Dallas/Ft. Worth International (DFW)

Love Field (DAL)

Arrival Date

Airline

Flight #

Arrival Time

Departure Date

Airline

Flight #

Departure Time

As part of our application process, all incoming students must have an interview and take an oral Gemara exam, and 3 written entrance exams. If you would like your son to take take these exams while he is in Dallas, please indicate below. (Please note that the interview and exams will be given on Sunday morning, so flights should be planned for later in the afternoon.) *

I would like my son to take an interview and all exams

Interview only

Exams only

My son will not be taking an interview or exams at this time

Please indicate any special considerations or conditions that are important for us to know about your son (Allergies, medications, etc.) *

By submitting this form and sending my son to participate in the Texas Torah Institute 8th Grade Shabbaton, I give my consent for my child to participate in all trips and activities, with transportation being provided by staff, authorized students, parents, paid carrier or other representatives of the school. I understand that by participating in these trips, my child will be exposed to the risk of serious injury, including, but not limited to injuries such as sprains, fractures and injuries that could result in brain damage, paralysis or even death. I understand that Texas Torah Institute does not assume any responsibility in case an accident occurs. In consideration for my child being permitted to take part in such activities and to make such trips, I hereby waive all claims, and I release, indemnify, defend and hold harmless Texas Torah Institute, Board of Directors, Headmaster, Academic Dean, faculty, agents, employees and invitees together with other persons, including parents of students of Texas Torah Institute assisting with any phase of such activities and trips(excluding paid certified carriers), from any and all liability claims, suits, demands or causes of action, including all expenses of litigation and/or settlement, which may arise in connection with such activities and trips, including any accident or injury suffered by my child while involved in such activities and trips.

Authorization of Passenger Permission for Student riding in Vehicles: I give my consent for my child to be a passenger in a vehicle with approval of the driver from school administration.