Hillel / JSA Fall Retreat 2015
AU Hillel and the Jewish Student Association are excited to host our second annual Fall Retreat, September 4-6, 2015, at the beautiful Capital Retreat Center in Waynesboro, Pennsylvania.
~ Make new friends
~ Share a meaningful, inclusive Shabbat experience
~ Enjoy campfires, swimming and other fun activities
~ Help to shape a great year of on-campus programming
Buses will transport students from campus to Capital Retreat Center and back. We will depart AU at 4:00 on Friday and will arrive back at approximately 1:30 on Sunday. Students are expected to participate in the full retreat; if you have extraordinary circumstances, contact the Hillel staff by August 27 to make special arrangements.
Hillel is offering subsidies to reduce the retreat cost for students. The actual cost per person is approximately $220, but we are happy to reduce that cost to $115 for new students and to $75 for all returning students who have applied to serve our community as "Big FYSH" peer mentors. The cost to students who do not fall into either of these groups is $130. In all cases the retreat price includes bus transportation to and from camp, two nights of accommodations, five meals, and all activities.
Beddings and linens will be provided. This includes blankets, sheets, pillows, pillow cases and towels. All food will be strictly kosher.
Your registration will only be considered complete once your payment has been submitted. Cancellation policy: Students who withdraw by August 27 will be refunded if the vacated spot can be filled. No refunds will be possible after August 27.
Questions? Email email@example.com.
AU ID #
Date of Birth
Expected Graduation Year
plan to pay the full, unsubsidized cost of the retreat ($220)
am a new student at AU this fall and would like to take advantage of the $105 new student subsidy
am a returning AU student, have applied to be a "Big FYSH" peer mentor this fall and would like to take advantage of the $145 "Big FYSH" subsidy
am not a new student, nor have I applied to be a "Big FYSH", but I would like to take advantage of the $90 subsidy available to all students
Parent / Guardian Name
Parent / Guardian Email
Parent / Guardian Phone
Parent / Guardian Address
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Please indicate any special dietary restrictions (vegetarian, allergies, etc.) Note that all food will be strictly kosher.
Trip / Event Conditions and Rules:
1. I understand that I am expected to follow the directions of the sponsoring organization;
2. the University and American University Hillel may take photographs and make other recordings of me during the trip / event. I consent to the use of my name and these photographs and recordings, without compensation, in any promotional materials and publications related to the educational activities of American University and American University Hillel; and
3. I understand that if I do not comply with these rules or otherwise conduct myself in a responsible manner, American University (“University”) or American University Hillel may remove me from the trip / event, and I will be sent home at my own cost.
Fitness to Participate and Emergency Medical Treatment:
1. I agree to conduct myself in a safe and prudent manner while participating in any activity or travel conducted by or under the auspices of American University and American University Hillel;
2. I represent to American University and American University Hillel that there are no health-related reasons or other problems of which I am aware that preclude or restrict me from participating in this trip / event;
3. I hereby authorize the University or American University Hillel to secure necessary emergency medical treatment in the event of injury or illness while participating in the trip / event; and
4. I acknowledge that I have adequate medical insurance coverage.
Assumption of Risk:
I understand that participation in the trip / event is voluntary. I understand that the trip / event will be held off campus and acknowledge that there are risks associated with traveling to and participating in the trip / event. Understanding these risks, I agree that I am knowingly and voluntarily assuming them.
I (including my parents, guardians, and legal representatives) agree that in consideration of my participation in the trip / event, I hereby agree to release, hold harmless and indemnify American University and American University Hillel, their trustees, officers, employees, faculty and agents from any and all claims and law suits for bodily injury, death, or loss to person or property which may result from my sustained by me while participating in or arising out of any travel or activity associated with the trip / event. I agree to conduct myself in a safe and prudent manner while participating in any activity or travel conducted under the auspices of this trip / event. I understand that while participating in any such activity or travel, I am subject to the university’s Code of Conduct.
I have read and understand the provisions above and agree to be bound by them.
I agree to participate fully in retreat activities.
I understand that I cannot possess or consume alcohol at any point during the retreat, regardless of my age.
I understand that the retreat will take place at a smoke-free camp and, therefore, I agree not to smoke for the duration of the retreat.
Do Not Fill This Out