Junior Tafkid Application Form

Email address*
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender*
- Male
- Female
Shevet (or if not known year group)*
Mobile Number*
Address*
Street Address ZIP / Postal Code Country
Do you have a current DBS?*
- Yes
- No
You will need a valid DBS before taking Machane. Please contact Zoe Daniels at [email protected] to arrange this.
If yes, what is your current valid DBS number?
Do you have Mas Chaver 5780? (you must have Mas Chaver 5780 to take Winter Machane)*
- Yes
- No
If you would like to sign up for Mas Chaver, you can do so by visiting bauk.org/mas-chaver, or paying at the end of this form.
If yes, what's your number?
Give a summary of your involvement with Bnei Akiva to date*
What are you doing this year?*
Why do you want to be involved in Bnei Akiva Machane?*
Which Tafkid would be your first choice?*
Which Tafkid would be your second choice?*

Emergency Contact Details
Please provide the contact information of someone who will be available for the entire duration of Machane
Name*
First Last
Relation to you*
Emergency Contact Phone Number*
If Bnei Akiva are worried about the state of your mental or physical health, the Designated Safeguarding Officer or Mazkira will contact your emergency contact.

References
Are you a first time madrich/a?*
- Yes
- No
Reference 1 Name*
First Last
Reference 1 Position (must be someone who has held a senior position in Bnei Akiva)*
Reference 1 Phone*
Reference 1 Email*
Reference 2 Name*
First Last
Reference 2 Position*
Reference 2 Phone*
Reference 2 Email*

Medical Details