Application Form - Vacation Gemach

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Everyone deserves a break. Let us help make that possible.

Please fill in as much information as you can. The more details you provide, the better we can understand your situation and how to help.

"*" indicates required fields

Your Name*

Your Email*

Your Number*

Home Address*

Family Members (Name and Ages)*

Two Rabbinical References & Testimonials (Rabbi's Name and Contact Information + a Testimonial by Them)*

Why do you feel you need a vacation?*

Tell us about your situation/challenges.*

Consent

I agree to give one weeks notice in order to cancel my vacation

I will stay the entire booking and not leave early unless there is an emergency

I have no steady or an insufficient source of income

I will provide a one paragraph anonymous Testimonial within a week of completion

I will not be taking another vacation this summer (excluding trips to see family out of town, or to attend a family simcha)

Failure to abide by these rules and conditions will cancel participation from future Recharge programming.

I understand that if I check in or out outside the scheduled times, I will be responsible for any additional costs.