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Shabbat Ha’Irgun – Borehamwood 5786!
Step
1
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2
50%
Parent Details
Event
Borehamwood Shabbat Ha’Irgun
Parent 1 Name (Primary Contact)
*
First
Last
Email
*
Parent 2 Name
First
Last
Email
Primary Contact Phone (Mob.)
*
Address
*
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Unless otherwise stated, the primary contact will also be considered the Emergency Contact for all children listed on this form. Would you like to include an alternate Emergency Contact?
*
Yes
No
Please give Emergency Contact details below, and state which child/ren they are responsible for:
How many adults are you booking for?
none
One
Two
Adult 1
Does the adult have any dietary requirements, or allergies?
Yes
No
Please give details below:
Adult 2
Does the adult have any dietary requirements, or allergies?
Yes
No
Please give details below:
The Motzei Shabbat Tochnit will take place at Hollywood bowl Finchley. Parents will be responsible for organising drop off and pick up. Please note, in order for us to book the correct amount of spaces, please make sure that bookings for High School aged Children are in by Monday 19th January. The sunday morning primary school activity will take place at Croxdale.
confirming details of both tochniot
Children's Details
How many children are you booking for?
One
Two
Three
Four
Five
Six
Child 1
Child 1 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Child 2
Child 2 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Child 3
Child 3 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Child 4
Child 4 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Child 5
Child 5 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Child 6
Child 6 Name
Date of Birth
DD slash MM slash YYYY
School
Shevet
Atid (Year 1/2)
Hachana Aleph (Year 3)
Hachana Bet (Year 4)
Zeraim (Year 5)
Nitzanim (Year 6)
Ma'alot (Year 7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Chavraya Gimmel (Year 10+)
Will be attending:
Child years 5-10- Family Friday night – £12.50
Child- years 2-10 – Shabbat Lunch £10
Motzei Shabbat Tochnit for high school y7-10- £10
Sunday tochnit for primary school y2-6- £7.50
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Does your child suffer from any allergies that we should be aware of? e.g. Plasters, penicillin, food? Please give full details below. Withholding information may endanger the health or well-being of your child.
Please give full details of any physical health conditions that may affect your child at sviva. e.g. Asthma, diabetes, epilepsy. Withholding information may endanger the health or well-being of your child.
Please give full details of any mental health condition that may affect your child at sviva. e.g. ADHD, eating disorders, anxiety. Withholding information may endanger the health or well-being of your child.
Terms and conditions (to be signed by parent/guardian if under 18)
I hereby declare that to the best of my knowledge, tthis medical form is accurate and complete in all its details. I understand that Bnei Akiva will not be responsible for any medical condition either physical or emotional, which may result from my failure to disclose relevant information. It is permissible for the designated First Aider to administer Savlon and plasterse, etc., for any minor ailments. I have read and agree to the above conditions.
Booking & Payment
Mas Chaver is membership of Bnei Akiva, and runs from Rosh Hashanah to Rosh Hashanah. Mas Chaver for this year (5785) began in September 2024 and you would have paid if you attended Winter Machane.
Mas Chaver (Membership)
Family Membership – £95
Individual Membership – £53
I already have Mas Chaver for 5784
I do not wish to purchase Mas Chaver at this time
If you are paying for participants not in your family, they will need to arrange their own Mas Chaver by visiting bauk.org/mas-chaver
Please note, we would never want anyone to miss out on a Bnei Akiva event due to financial reasons. We therefore have funds available to help families in need of extra financial support. Please get in touch with Michal via mazkira@bauk.org in confidence.
Adult ticket for Family Friday Night Dinner
Quantity
Price:
£ 12.50
Quantity
Family Friday night years 5-10
Quantity
Price:
£ 12.50
Quantity
Shabbat lunch years 2-10
Quantity
Price:
£ 10.00
Quantity
Years 7-10 for the motzei Shabbat tochnit
Quantity
Price:
£ 10.00
Quantity
years 2-6 Sunday Tochnit
Quantity
Price:
£ 7.50
Quantity
I would like to donate a different amount of:
I am happy for Bnei Akiva and Friends of Bnei Akiva (BACHAD) to contact me about future events and news.
*
Yes
No
Total
£ 0.00
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