Nemerim Weekend Application Form
HABONIM DROR UNITED KINGDOM - NEMERIM WEEKEND 2018 REGISTRATION FORM

COST: £75

Please complete the form in full. Feel free to add any additional information. If you have any questions about this contact Adi at adi@habodror.org.uk or 0208 209 2111


WEEKEND DATES: 23-25th November

Email address *
Child's Details
First name *
Your answer
Last Name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Mobile Number *
Your answer
Tetanus *
Allergies *
If none please write none
Your answer
Please notify us of any medical conditions (Physical, mental, dental, optical or other). *
If none please write none
Your answer
Prescribed medication (must be brought on weekend) *
If none please write none
Your answer
Other (social) - please specify *
In order to ensure you have the best possible experience please let us know if you have any specific needs that we should keep in mind while caring for you. E.g. dyslexia, mild attention disorders, emotional sensitivity to specific situations (You should repeat any information given above under 'Medical Conditions' as relevant).
Your answer
Dietary Requirements *
Your answer
City travelling from (before weekend) *
Your answer
City traveling to (after weekend) *
Your answer
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