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Parent 1:

Email Address*

First Name*

Last Name*

Address, line 1*

City*

Zip Code*

Parent 2 (if applicable):

First and Last Name, Email Address

Names and Ages of children*

Are there any additional individuals living in the home?*

How did you hear about the Shinshinim program?

Please describe your family’s weekly schedule.

What are some of your favorite family activities?

Does either parent work from home?*

Yes No

Does anyone in your household smoke?

Yes No

Do any of your family members have severe food allergies?

Yes No

Please indicate if your family keeps kosher:

Strictly kosher Kosher style Not kosher

Is anyone in your household a vegetarian?

Yes No

Would you be able to accommodate a Shinshin that is vegetarian?

Yes No

Does your family have any Shabbat practices or traditions?

Do you have any pets? If yes, please elaborate.

Please describe your family’s community affiliations

Has anyone in your household been to Israel?

Yes No

Does anyone in your household speak Hebrew?

Yes No

What made your family want to host a Shinshin?

Please state the best season(s) of the year to host

Comments / Questions / Additional Information

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