FAMILY INFORMATION SHEET

A journey to Poland with JRoots is an opportunity to step back into the story of the Jewish people. In order to enrich this experience it is important to connect with personal stories of participants in the group wherever possible.

We therefore ask that before the trip you find answers to the following questions and return this sheet to us. We can't guarantee that we can include all family sites and stories but where practical and possible we will endeavour to mention them during our journey.

Walking the steps of Jewish history whilst having your own family history in mind will enhance your personal journey.

Please fill in the form below.

Name

Name of Trip

Email Address

Telephone Number

MOTHER’S SIDE

GRANDMOTHER

Name

D.O.B

Place of birth

Great GRANDMOTHER

Name

D.O.B

Place of birth

Great Grandfather

Name

D.O.B

Place of birth

Grandfather

Name

D.O.B

Place of birth

Great GRANDMOTHER

Name

D.O.B

Place of birth

Great Grandfather

Name

D.O.B

Place of birth

FATHER’S SIDE

GRANDMOTHER

Name

D.O.B

Place of birth

Great GRANDMOTHER

Name

D.O.B

Place of birth

Great Grandfather

Name

D.O.B

Place of birth

Grandfather

Name

D.O.B

Place of birth

Great GRANDMOTHER

Name

D.O.B

Place of birth

Great Grandfather

Name

D.O.B

Place of birth

Please include here any additional information which may be of relevance to your journey to Poland (particular places they may have lived or any particular experiences during the Holocaust which you are aware of).

Destinations

LEARNING RESOURCES

CONTACT

info@jroots.org

USA: +1 646 448 0348
UK: +44 (0) 20 8457 2121
ISL: +972 (0)527969953

Name	Name of Trip


Email	Telephone Number

MOTHER’S SIDE

GRANDMOTHER	Name	DOB	Place of birth
GRANDMOTHER

Great GRANDMOTHER	Name	DOB	Place of birth
Great GRANDMOTHER

Great Grandfather	Name	DOB	Place of birth
Great Grandfather

Grandfather	Name	DOB	Place of birth
Grandfather

Great GRANDMOTHER	Name	DOB	Place of birth
Great GRANDMOTHER

Great Grandfather	Name	DOB	Place of birth
Great Grandfather

FATHER’S SIDE

GRANDMOTHER	Name	DOB	Place of birth
GRANDMOTHER

Great GRANDMOTHER	Name	DOB	Place of birth
Great GRANDMOTHER

Great Grandfather	Name	DOB	Place of birth
Great Grandfather

Grandfather	Name	DOB	Place of birth
Grandfather

Great GRANDMOTHER	Name	DOB	Place of birth
Great GRANDMOTHER

Great Grandfather	Name	DOB	Place of birth
Great Grandfather

Additional Information

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info@jroots.org

USA: +1 646 448 0348

UK: +44 (0) 20 8457 2121

ISL: +972 (0)527969953