Bnei Akiva UK | Sukkah Crawl

Sign Up & Medical Form for the whole year

"*" indicates required fields

Child's Name*

First Last

Gender*

Male

Female

Date of Birth*

School*

Hidden

Sviva (old)*

This is the location of your Bnei Akiva group e.g. Golders Green

Sviva*

This is the location of your Bnei Akiva group e.g. Golders Green

Shevet (Year Group)*

Emergency Contact Name*

First Last

Emergency Contact Mobile Number*

Emergency Contact Home Telephone Number*

Email address*

Emergency Contact Address*

Street Address Address Line 2 City Post Code Country

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.*

Approximate date of last Tetanus injection*

Do you feel that your child will need any extra support at sviva? If so, please contact welfare@bauk.org

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.

I am happy to be added to any local Facebook or WhatsApp groups where information about my local Sviva will be shared by the Rosh and Madrichim.

Yes

I give permission for Bnei Akiva and Bachad to contact me and those listed in this form in regards to Bnei Akiva/Bachad events.

Agree

Sviva Signup Fee*

This helps to cover the running costs of Sviva including administration, food, and madrichim's training.

Sviva Annual Costs - £20.00

Total

Credit Card*

Sukkah Crawl Specific Sign Up

IN ORDER TO BEST CARE FOR YOUR CHILD, WE REQUIRE ALL PARTICIANTS OF SVIVA EVENTS TO HAVE FILLED OUT THE SVIVA MEDICAL FORM. IF YOU HAVE NOT ALREADY DONE SO, PLEASE VISIT https://www.bauk.org/svivot-medical-form/ BEFORE THEY ATTEND

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

Parent/Guardian Phone(Required)

Parent/Guardian Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Which Sviva will your children be attending?(Required)

How many children are you booking for?(Required)

Is it your first time at BA?(Required)

Yes

Child 1

Name(Required)

First Last

Shevet (Year Group)(Required)

Child 2

Name(Required)

First Last

Shevet (Year Group)(Required)

Child 3

Name(Required)

First Last

Shevet (Year Group)(Required)

Child 4

Name(Required)

First Last

Shevet (Year Group)(Required)

Are you planning on bringing friends?(Required)

Yes

If so, how many?(Required)

Is it your friend's first time at BA?(Required)

Yes

Please Register using both forms. Please fill out a seperate registration & medical form for each child.

Sign Up & Medical Form for the whole year

Sukkah Crawl Specific Sign Up

Child 1

Child 2

Child 3

Child 4

London

Manchester

Our Policies

Our Policies