Senior Winter Camp: Machane Muda'ut Chevratit (Social Awareness)
HABONIM DROR AOTEAROA NEW ZEALAND - Senior Winter Camp 2016 APPLICATION FORM

DATE: SUNDAY 10th - SUNDAY 17th July 2014

We ask you take the time to complete this form in full to enable us to take the best care of your children. Please add any additional information. If you have any questions about this please contact Rosh Machane, Adi Rothman Berman at seniorwintercamp@habo.co.nz or 0211317066

First Name *
Your answer
Last Name *
Your answer
Date of Birth *
DD/MM/YYYY
Your answer
Chanich/a's email
Your answer
Family email *
Your answer
Chanich/a's cellphone
Your answer
Family contact phone number *
Your answer
Parent cellphone *
Your answer
Street name and number *
Your answer
Suburb *
Your answer
City *
Your answer
Alternative emergency contact name *
Your answer
Alternative emergency contact number *
Your answer
Habo group 2016 *
Tetanus and immunisations *
Allergies *
If none please write none
Your answer
Medication (must be brought to camp) *
If none please write none
Your answer
Other - please specify e.g dietary requirements *
If none please write none
Your answer
City travelling from (before camp) *
Your answer
City travelling to (after camp) *
Your answer
Payment *
This camp cost covers transport, food and activities over the week. Please get in touch with our gizbar (treasurer) Tomer Simhony on gizbarut@habo.co.nz if you wish to arrange a payment plan to suit your family's needs. WARNING: Kids signing up after 26 June will incur additional fees due to increased transport costs from signing up late.
Scholarship fund
Preferred payment method *
If you are hesitant in sending your child to a camp due to financial reasons, you may be eligible for our subsidy fund. Please contact our gizbar (treasurer) Tomer Simhony at gizbarut@habo.co.nz to apply for this subsidy. All enquiries and/or applications will be treated with the utmost of confidentiality.
Additional information
Please feel free to add anything you feel it is important for Habonim Dror to know about your family or your child in regards to this camp.
Your answer
Camp Rules to be read and signed by the chanich/a - please sign with your name and the date *
- No illegal substances - No weapons, including pocket knives - No cellphones or video games during activities - No bullying - No antisocial behaviour - No leaving the camp without permission. I have read the rules for Habonim Dror Senior Winter Camp, and agree to abide by them.
Your answer
DISCLAIMER and WAIVER OF LIABILITY *
Please tick the boxes to indicate that you have read it and are in agreement with it.
Required
Please sign the disclaimer and waiver of liability with your name and the date *
Your answer
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