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Parent Details
Event
Salford Family Friday Night
Parent 1 Name (Primary Contact)
*
First
Last
Parent 2 Name
First
Last
Primary Contact Email
*
Primary Contact Phone (Mob.)
*
Address
*
Street Address
Address Line 2
City
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ZIP / Postal Code
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If you (the parents) are planning on attending any meals, please give dietary/allergy information below:
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:
Children's Details
How many children are you booking for?
One
Two
Three
Four
Five
Six
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
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+)
Does this child have any dietary/medical requirements, or allergies?
Yes
No
Please give details below:
Booking & Payment
Mas Chaver is membership of Bnei Akiva, and runs from Rosh Hashanah to Rosh Hashanah. Mas Chaver for this year (5784) began in September 2023 and you will have paid if you have signed up for Winter Machane.
Mas Chaver (Membership)
Family Membership - £95
Individual Membership (Year 6-12) - £53
Individual Membership (Year 1-6) - £25
I already have Mas Chaver for 5785
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
I am happy for Bnei Akiva and Friends of Bnei Akiva (BACHAD) to contact me about future events and news.
Yes
No
Family Ticket Salford
Quantity
Price:
£ 45.00
Quantity
Two adults, two children
Adult Ticket Salford
Quantity
Price:
£ 15.00
Quantity
Child Ticket (Age 12 and over) salford
Quantity
Price:
£ 12.50
Quantity
Child Ticket (Under age 12) Salford
Quantity
Price:
£ 10.00
Quantity
Child Ticket (Under age 3) Salford
Quantity
Price:
£ 0.00
Quantity
Madrich/a Ticket Salford
Quantity
Price:
£ 5.00
Quantity
Total
£ 0.00
Credit Card
Card Details
Cardholder Name
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