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Shabbat Ha'Irgun - South Hampstead
Step
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3
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Parent Details
Event
South Hampstead 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
Afghanistan
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Anguilla
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Antigua and Barbuda
Argentina
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Aruba
Australia
Austria
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Belize
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Bolivia
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Bouvet Island
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Cook Islands
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Virgin Islands, U.S.
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Country
Parent 1 will be attending
£13 - Friday Night Dinner
Parent 2 will be attending
£13 - Friday Night Dinner
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?
None - I just want to sponsor the bencher
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 (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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+)
Will be attending:
Child (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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+)
Will be attending:
Child (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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+)
Will be attending:
Child (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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+)
Will be attending:
Child (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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+)
Will be attending:
Child (Aged 12+) - Friday Night Dinner - £13
Child (Aged 12 and under) - Friday Night Dinner - £10
Child (Aged 12+) - Shabbat Lunch - £13
Child (Aged 12 and under) - Shabbat Lunch - £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 (5783) began in September 2022 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 5783
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 Rafi via
[email protected]
in confidence.
South Hampstead BA Friday Night Dinner Total
Price:
£ 0.00
South Hampstead BA Shabbat Lunch Total
Price:
£ 0.00
We will be producing a special bencher for Shabbat Ha'Irgun. If you would like to include a message for the community, you can do so below.
Bencher Sponsorship
£52 - Full Page
£26 - Half Page
£13 - Quarter Page
Other
Please note, this donation will not be eligible for Gift Aid. If you would like to make a Gift Aid-able donation to Friends of Bnei Akiva for the bencher, you can do so at www.bauk.org/donate
I would like to donate a different amount of:
My message:
If you would like a business logo or advert included, please send artwork to
[email protected]
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
Credit Card
Card Details
Cardholder Name
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