Application and Medical Form for Winter Machane

Section 1: Applicant's Details

Camp applying for?*

Aleph (Years 6/7)
Ma'apilim (Year 8)
Haroeh (Year 9)
Gimmel (Year 10)
H-Course (Year 12)

You do not need to pay anything on this form. This is a form for the waiting list. Once your application has been received we will let you know if a space opens up.

Is this the applicant’s first time at Bnei Akiva Machane?*

Yes
No

Applicant's Name*

First Last

Gender*

Male
Female

Date of Birth*

School*

School Year*

Sviva

Other Sviva - Please specify

Please list two friends you would like to be in a group/share a room with?*

Parent/Guardian 1

Title*

Name*

First Last

Telephone (Home)*

Telephone (Mobile)*

Email*

Synagogue*

Marital Status

Parent/Guardian 2

Title

Name

First Last

Telephone (Home)

Telephone (Mobile)

Email

Synagogue

Marital Status

Application and Medical Form for Winter Machane

Section 1: Applicant's Details

Parent/Guardian 1

Parent/Guardian 2

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London

Manchester

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