BBYO • 2018-19 Convention Registration Form

Teen Information

First Name (as to appear on nametag) : 
Last Name : 
Gender : 
 Male  Female  Other
Age : 
Birthdate : 
High School Graduation Yr : 
Address : 
City, State, Zip : 
Home Phone # : 
Teen Cell Phone # : 
Email : 
Synagogue (if none, please enter N/A) :
School : 
BBYO Chapter : 
T-shirt size : 
S  M  L  XL  XXL
Please select which bus you would prefer to ride. Buses will be filled on a first-come first-served basis, and we will let you know if we cannot accommodate your request. Please note that there will not be bus service to Kallah or ASC.

Emergency Contact

First Name : 
Last Name : 
Cell Phone # :

Dietary/Medical Information

All convention meals will either be vegetarian or include kosher meat (possibly cooked in a non-kosher kitchen). Please share any medical information, allergies, or dietary restrictions that we should know about.
Do you have any allergies or special dietary needs? Please explain.
Please list and explain any recent physical or mental illness, injury, or infection :
Please identify all medications which need to be administered during the convention(s). Include name of medication, purpose, dosage, and special care.
Med #1:
Med #2:
Med #3:

BBYO Medication Management Policy: In accordance with BBYO International rules, teens are expected to take medication on their own unless otherwise stated by a parent or guardian to staff. Medication, over-the-counter or prescription, cannot be shared between teens and may result in dismissal from the program. Over-the-counter medication is available to be given out by staff if needed.

Parent/Guardian Information

Parent/Guardian 1
First Name : 
Last Name : 
Address : 
City, State, Zip : 
Home Phone # : 
Cell Phone # : 
Email : 

Parent/Guardian 2
First Name : 
Last Name : 
Address : 
City, State, Zip : 
Home Phone # : 
Cell Phone # : 
Email : 

Convention Registration

Online registration for conventions closes 10 days prior to each convention. All registrations after that time must be made by calling the BBYO office at 678.812.3970, and will only be confirmed if space is available with a $25 late fee per registration.

We offer financial assistance for all conventions and packages. To be considered, please select the scholarship option under Payment Information, and contact Paige Godfrey ( with any questions. Click here for more information about financial assistance for local conventions.

A la Carte
This table allows you to register for individual conventions. To register for multiple conventions see our packages below.
Sign Me Up
Leadership Training Institute (LTI)
Grades 10-12 only
Location: Camp Coleman
Dates: 8/17-19
Cost: $285 before 8/1, $310 starting 8/2

New Member Convention (NMC)
Location: Rock Eagle 4-H Center
Dates: 10/12-14
Cost: $280 before 9/24, $305 starting 9/24

Spirit Regional Convention (SRC)
Location: Rock Eagle 4-H Center
Dates: 11/30-12/2
Cost: $310 before 11/1, $335 starting 11/1

Greater Atlanta Kallah
Location: Le Meridien Atlanta Perimeter
Dates: 1/18-20
Cost: $310 before 12/20, $335 starting 12/20

Atlanta Spring Convention (ASC)
Location: Atlanta Marriott Perimeter Center
Dates: 3/22-24
Cost: $310 before 2/22, $335 starting 2/22

BBYO Family Shabbat Dinner - March 22, 2019

The Shabbat Dinner is included for teens with the ASC registration fee. If your teen is attending the convention they do not need to purchase a ticket.

All donors will be listed in the evening’s program, regardless of the size of their contribution.

Support BBYO


 Family Shabbat Dinner Tickets Only - $40/pp (price increases to $46 after February 22)
No. of tickets

 I am unable to attend Family Shabbat Dinner, but would love to make a donation:

Attendee Information
Will your teen(s) be attending ASC?
If yes, please list full name and grade.
Please list the names of all family members & guests attending dinner:
Please let us know if you have any dietary restrictions or allergies:
If you would like to sit with a friend or family please let us know.

Donor Information

Program Listing :

If you selected a donor level please let us know how you would like to appear in the program. If you wish to remain anonymous, please leave this field blank.

Medical Release

 This is to indicate that our child has our permission to attend an Atlanta Council BBYO convention. While we expect the MJCCA staff to take necessary health and safety precautions, we understand that MJCCA is NOT responsible for illness or accidents during or in transit to or from the destination of the convention. We relieve MJCCA of liability should an accident occur.

The MJCCA assumes no liability for injury or damages arising from the results of participation in this BBYO program unless due to willful fault or gross negligence on the part of the MJCCA. Due to the strenuous nature of some activities, the participant is urged to consult his/her physician concerning his/her fitness to participate. All activities present certain inherent risks and hazards which the participant is urged to consider and which the participant assumes.

This is to certify that my child is in good health and may participate in all activities. I hereby approve and certify my child's participation in this program and consent to emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child's participation.

In the event that I cannot be reached in an emergency, I hereby give permission to the BBYO Director or MJCCA staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.


I agree to abide by the policies of the BBYO Member Code of Conduct. I understand that the BBYO staff has the authority to search my belongings if any suspicion whatsoever arises that I have violated any of these policies.

BBYO members are expected to behave in an appropriate manner at convention. Please be aware that your teen will be sent home or there will be a suspension from BBYO for inappropriate behavior and you may be charged with any damages that incur as a result of your teen's behavior. We trust our BBYO members to act responsibly and respect the facility's property.

It is our expectation that you will sit down with your teen and review the convention policies on this application form. Please review the following rules. 1. All convention participants must attend every scheduled event on time. 2. Participants must remain at activities at all times unless they have permission from the staff. 3. There will be a curfew after all scheduled events. 4. Everyone must be in his or her respective rooms by curfew. 5. There will be no use, possession, or distribution of alcohol, tobacco, or illegal substances at any time during the convention; this includes drug paraphernalia, incense, and e-cigarettes. 6. Participants must remain at convention unless they have pre-approval of the Council Director. 7. Visitors are not allowed without the pre-approval of the Council Director. 8. NO boys in girls' rooms, NO girls in boys' rooms. 9. Destruction of property, theft or vandalism may result in suspension from BBYO. 10. Full payment of property damage will be charged to the individuals found to be responsible for damage. 11. There will be room inspections on Sunday morning before breakfast. 12. Members will be sent home for inappropriate sexual behavior.



Payment Information

Please check and fill out one of the payment options below :
   I am paying in full.
 For package pricing only: I will be paying the deposit now and pay the balance with monthly payments.
Please charge me on  1st  15th 
 I am applying for a scholarship with a $75 deposit.
Total Charge : 
Card Type :  Visa  MasterCard  AmEx  Discover
Name on Card : 
Credit Card # : 
Expiration : 

NEW Cancellation & Refund Policy

 By checking this box I confirm I have read and accept the following conditions of the new NEW CANCELLATION AND REFUND POLICY:

  • Cancellation requests must be made in writing by sending an email to Full refunds will be provided for cancellations requested prior to 11:59 pm the Sunday before convention. Any requests made starting on Monday will be refunded with half of the registration fee.
  • Teens asked to leave convention for disciplinary reasons will not receive a refund.
  • MJCCA/BBYO reserves the right to cancel any convention due to insufficient enrollment. Should this occur, we will refund all payments in full.
  • MJCCA/BBYO reserves the right to cancel any convention due to circumstances beyond our control (inclement weather, natural disaster, etc.). Should this occur, a refund may not be available to participants.
  • Please allow four to six weeks for refunds to be processed.