Event Registration for Rooted

First Name: Last Name: Which of the following best describes you: Email: Phone: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Number of participants: jkid4ALL programs are for Jewish families of color. Please check this box to confirm you are a jkid4ALL family. Do you receive PJ Library and/or PJ Our Way books? May we use photos of your family in our promotional materials/Facebook? If you're going to any in-person events, do you or anyone in your family have any dietary restrictions? (All food at the program will be kosher.) If you're going to any in-person events, will you need childcare? If you said yes, age(s) of child(ren): Will anyone in your group require accommodations in order to attend this event? (Please describe)