Yosemite Trip for 4th and 5th Grade Tuesday, June 10 - Thursday, June 12 For questions, please contact: [email protected] Parent Name First Name Last Name Student Name First Name Last Name Grade My Child: will be attending the trip.will not be attending the trip. Trip Cost: $550 (includes all travel and food related expenses) Hebrew Academy believes that all students should have access to these types of enriching experiences, regardless of their family's financial situation and will be offering a subsidized rate of $375 ($175 discount). While we understand that the subsidy may be helpful to some families, we encourage you to consider paying the full amount if possible. By doing so, you will be helping to support the school and ensure that we can continue to offer these types of opportunities to all of our students. Payment options: Option One: One payment $550 One payment $375 Option Two: Pay in three installments: Payments due 4/4, 5/15 and 6/9 Option Three: Payment arrangement made with Rabbi Popack I will be paying:* Full Amount ($550)Subsidized Rate ($375)) Payment Options (Full Amount): 1st Installment payment of $2002nd Installment payment of $1753rd Installment subsidized payment of $175Full $550 Payment Options (Subsidized Rate): 1st Installment payment of $1452nd Installment payment of $1153rd Installment subsidized payment of $115Full $375 Other Amount $ All students and chaperones will be receiving a complimentary grand trip t-shirt. If you wish you may order more at $15 per shirt. Please select your preferred t-shirt size for the grand trip. Youth sizes available: S, M, L, XL. Adult sizes available: S, M, L, XL, XXL. Please Enter Number of Extra Shirts Shirt Size Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large Count me in! I'd love to help ensure that every child gets to experience this special trip. Sponsorship Amount $ Total $0.00 Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country E-mail Address For receipt Submit Should be Empty: This page uses TLS encryption to keep your data secure.