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Special Excursion Information Form
Grade 6 & 7 Retreat

Parents/Guardians:

The purpose of this form is to get support and permission for your child to participate in the Grade 6&7 retreat, as well as to collect any pertinent medical etc. information that staff will need while away with your child. 
 
*Please note, this retreat is a part of the Grade 6&7 program, and the cost of the retreat is a part of your child's tuition for the year.

Destination: YMCA Cedar Glen Camp, Schomberg Ontario

Dates: Friday, November 6 - Saturday, November 7, 2026

Accompanying Staff: Lisa Isen Baumal, Zoey Wallhouse, Grade 7 teachers, Cantor Rosen and Rabbi Kaye

Departure time from Holy Blossom Temple: Friday, November 6 at 4:15 PM
Return time to Holy Blossom Temple: Saturday, November 7 at 8:00 PM

Method of Travel: School Bus
Parent/Guardian








Thank you - the participant fee is included in tuition for the year.
Should it become necessary for my child to have medical care, I hereby give permission to use his/her best judgement in obtaining the best of such service for my child. I understand that any cost will be my responsibility. I also understand that in the event of illness or accident I will be notified as soon as possible. In the event that I cannot be reached please contact the alternate contact listed below







Medications



Emergency Contact 
Please provide an alternate emergency contact to the parent listed above. 



Roommate Request
My child requests to room with: 
Thank you. We will do our best to accommodate these requests.
Fee & Payment

$
Credit Card Information






Billing address must match the address associated with the credit card. 

Visa or Mastercard





Contact Information