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L'Taken Social Justice Seminar
(Grades 9 - 12)

L'Taken Social Justice Seminar 2017

Registration Form
Friday to Monday February 24 - 27, 2017.

Join teens from all over the country in this incredibly meaningful seminar in Washington, DC. You will have the opportunity to impact our political process as you share your views on social justice topics with decision-makers on Capitol Hill. You will attend programs on a range of topics, including Israel, the environment, reproductive rights, LGBTQ civil rights, church/state separation, international relations and more. Throughout the weekend, you will learn how to write an effective, persuasive and passionate speech on a topic of your choice to present when you visit the offices of your Senators and Representatives!

Program cost: $850, includes all travel expenses and seminar registration. No refunds available after December 1, 2016. Cancellations prior to December 8, 2016 are subject to a $50 non-refundable deposit.

Child Full Names
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Consent Statements

Parental Consent and General Release Statement
I give permission to my child/ren to participate in all of Wilshire Boulevard Temple’s Religious School/Youth Group programs, activities and events and release Wilshire Boulevard Temple and its representatives from all liability arising out of my child/ren’s participation in such activities. I grant power to Wilshire Boulevard Temple to take photographs, movies, videos of my child/ren while my child/ren is/are participating in Wilshire Boulevard Temple activities and for Wilshire Boulevard Temple the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release Wilshire Boulevard Temple from all claims, demands, and liabilities whatsoever in connection with the above.
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Emergency Information and Care
I/we hereby give permission for the above named child/ren to be given emergency care as administered, authorized or directed by any adult person acting on behalf of Wilshire Boulevard Temple Religious Schools. Such care may include x-ray examination rendered to said minor/s under the provisions of the Medicine Practice Act; anesthetic, dental or surgical diagnosis or treatment or hospital care to be rendered to said minor/s by a dentist licensed under the provisions of the Dental Practice Act, all pursuant to Civil Code 25.8. I/we further agree to pay the cost of all such medical or dental services. It is understood that if time and circumstances reasonably permit, Wilshire Boulevard Temple Religious School personnel will try, but not be required, to communicate with me prior to such treatment.
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Wilshire Boulevard Temple

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