Israeli Youth Hosting Form

For your legibility, please fill in the form on screen then print and mail it.

Name(s):  
Address:  
City/Zip:            Phone number (for chain): 
Phones:   Day:       Evening:          Cell:  
e-mail:     ID:

Children's info:

Name:   Age:      Phone: 
Name:   Age:      Phone: 
Name:   Age:      Phone: 
Name:   Age:      Phone: 

Lifestyle:

Do you keep a kosher home? Yes   No
    If yes, do you go to non-kosher restaurants? Yes   No

Do you travel or work on Shabbat? Yes   No

Walking distance from the synagogue:

Pets: (describe)

Lanuage(s) spoken or understood:

Dietary or other considerations (restrictions, allergies, vegan, vegetarian, etc.)

Pre-existing commitments & dates. e.g. school, sports, SAT prep. work, etc.


Mail to:
Congregation B'nai Tikvah
Attn: Youth Exchange
1001 Finnegans Lane
North Brunswick, NJ 08902