Year 12 Application 5786

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Year 12 Application 5786

SECTION 1: APPLICANT DETAILS

Name(Required)

First Last

Gender(Required)

Male

Female

Date of Birth(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

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

Mobile number (with WhatsApp)(Required)

Primary School(Required)

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

High School(Required)

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

Synagogue(Required)

If 'Other', which synagogue are you a member of?

Are you part of a youth movement? If so, which?(Required)

Please list any dietary requirements

Please provide a reference (this can be a teacher, Madrich, etc)

Reference Name(Required)

Reference Phone
If available, not required

Reference Email(Required)

SECTION 2: the T's & C's

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 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

We would love to stay in touch with you by email 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 let us know if we can contact you.

Opt-In
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.