Yehudi | Year 13 Shabbaton 5784

Year 13 Shabbaton Form 5784

The year 13 Shabbaton will be held at the Lincolnsfield Centre on 8th September. If you would like to apply for financial assistance for the cost of this programme and Shabbaton (£99), please email lelia@mizrachi.org with the subject line "Yehudi FA".

SECTION 1: APPLICANT DETAILS

First Name(Required)

Last Name(Required)

Gender(Required)

Male

Female

Date of Birth(Required)

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

Email(Required)

Enter Email Confirm Email

Address(Required)

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

Mobile number (with WhatsApp)(Required)

Dietary Requirements?(Required)

Yes

No

Please list your dietary requirements

Section 2: PARENT/GUARDIAN(S)

Parent/Guardian 1

Title(Required)

First name(Required)

Last Name(Required)

Mobile phone(Required)

Home phone

Email(Required)

Address(Required)

Same as previous

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

Parent/Guardian 2

Title

First name

Last Name

Mobile phone

Home phone

Email

Address

Same as previous

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

SECTION 4: EMERGENCY CONTACT

Please note: in the event of an emergency, the parents will usually be contacted first. However. in the event the parent's are non contactable, please list an emergency contact

Title(Required)

First Name(Required)

Last Name(Required)

Mobile Phone(Required)

Home Phone

Email(Required)

SECTION 5: T&Cs

I agree that any violation of the T&Cs will result in my immediate removal from the programme 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 agree to only bring medication declared above on the trip.(Required)

I Agree

I Disagree

I agree to the T&Cs and cancellation policy found here: yehudi.co.uk/t-cs(Required)

I Agree

I Disagree

I consent for myself and my parent(s)/guardian(s) 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. Email daniel.sacks@mizrachi.org with the subject line "GDPR Request" for any queries or to remove your information.(Required)

I Agree

I Disagree

I hereby certify the above information is correct and confirm my answers are honest

SECTION 6: PAYMENT

Would you like to purchase a YeHoodie? These are priced at £20

If yes, please select your size

The Shabbaton is mandatory and is at the cost of £99

Coupon

Total

Credit Card(Required)

Card Details

Cardholder Name

Comments

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