Yom Yerushalayim 5786

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This field is for validation purposes and should be left unchanged.

Tuesday 11th May - Sunday 17th May

SECTION 1: APPLICANT DETAILS

Name(Required)

First Middle Last

PLEASE ENSURE YOU USE YOUR NAME AS WRITTEN IN YOUR PASSPORT THROUGHOUT THIS FORM

Known as

If you are known by a different name to what is written on your passport (for example, a Hebrew name), please write this here.

You are:(Required)

Year 12 Madrich/a on Yehudi

A Mentor on Yehudi

Is this the applicant's first time on a residential trip?

Yes

Please list two friends to share a room with - this is not a guarantee, but we will try

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address City County / State / Region ZIP / Postal Code

Mobile number (with WhatsApp)(Required)

High School(Required)

If 'Other', which high school did you attend?

Section 2: PASSPORT DETAILS

Please fill this section in carefully. Yehudi will not be responsible for any issues caused due to incorrect passport information. Your name above should match the name in your passport EXACTLY.

I confirm the passport will have 6 months left from the date the trip returns(Required)

Yes

Nationality(Required)

Passport number(Required)

Date of birth(Required)

Passport expiry date(Required)

Gender(Required)

Male

Female

Section 3: PARENT/GUARDIAN(S)

Parent/Guardian 1

Name - Parent/Guardian 1(Required)

Prefix First Last

Mobile phone - Parent/Guardian 1(Required)

Home phone - Parent/Guardian 1

Email - Parent/Guardian 1(Required)

Address - Parent/Guardian 1(Required)

Same as previous

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Parent/Guardian 2

Name - Parent/Guardian 2

Prefix First Last

Mobile phone - Parent/Guardian 2

Home phone - Parent/Guardian 2

Email - Parent/Guardian 2

Address - Parent/Guardian 2

Same as previous

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

SECTION 4: MEDICAL AND WELFARE INFORMATION

Doctor's Name(Required)

Name of Practice(Required)

Practice Address(Required)

Doctor's Phone Number(Required)

Do you take regular medication? If so, please provide details.(Required)

Do you have any allergies?(Required)

Do you suffer from any of the following: asthma, hyperventilation, panic attacks, skin disorder, diabetes, Hay Fever(Required)

Yes

Do you carry an inhaler?(Required)

Yes

Do you carry an epi pen?(Required)

Yes

Is there anything else (family background, medical) that Yehudi Welfare should be aware of?(Required)

Yes

Have you ever been diagnosed with any condition which Yehudi Welfare should be made aware of? e.g., Dyslexia, ADHD, Hyperactivity, Hypermobility, eating disorder, self-harm, autism spectrum, Asperger’s syndrome, anxiety, OCD, any mental health related disorder? If yes, please give details below.(Required)

Yes

If you answered 'Yes' to any of the above questions, please provide details

Have you ever been excluded from school or a youth movement or ever been sent home early from a residential trip?(Required)

Yes

If you answered yes to the above, please provide details.

SECTION 5: T&Cs

I agree that any violation of the T&Cs will result in my immediate removal from the trip and I explicitly agree to cover any associated costs with doing so, including, but not limited to, a return trip home or repaying subsidies.(Required)

I Agree

I Disagree

I consent to the participant being in photos on the trip and consent to these photos possibly being used for marketing purposes in the future.(Required)

I agree

I disagree

Please see the photos policy at yehudi.co.uk/t-cs

I consent to the use of my number for purpose related to Yehudi. This may include being added to a WhatsApp group or communicating with stakeholders.(Required)

I Agree

I Disagree

I agree to only bring medication declared above on the trip.(Required)

I Agree

I Disagree

Terms and Conditions and Cancellation Policy(Required)

I Agree to the Terms and Conditions

I consent for all named people above to be contacted by Yehudi and Mizrachi UK for matters relating to the programme, Mizrachi UK programming, fundraising and any other relevant reasons, as deemed fit. All data wil be held in accordance with GDPR.(Required)

I Agree

I Disagree

We would love to stay in touch with you and let you know about our vital services, our education work, events and fundraising. Your privacy is important to us, and we need your consent in order to communicate with you. Please select all the ways we can contact you.

Post

Phone

By providing this information I confirm that I am consenting to Mizrachi holding and processing my personal data to keep me informed about Mizrachi's services, courses, events and fundraising. Where you do not grant consent we will not be able to use your personal data; (so for example we may not be able to let you know about forthcoming services and events); except in certain limited situations, such as where required to do so by law or to protect members of the public from serious harm. You can find out more about how we use your data and how to withdraw your consent from our Privacy Notice.

SECTION 6: PAYMENT

What size t-shirt are you?(Required)

Yom Yerushalayim Trip 2026(Required)

Full Price - £799

Discounted Rate - £699

Coupon

Total for Yom Yerushalayim Trip 2026

Credit Card(Required)

Some users may experience problems using Mastercard. If your Mastercard does not work, please try a different card.

Card Details

Cardholder Name