Pre-Nemerim Weekend Application Form
HABONIM DROR UNITED KINGDOM  - PRE-NEMERIM WEEKEND 2019 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 Harry at harry@habodror.org.uk or 0161 795 9447


WEEKEND DATES: 8-10th March

WEEKEND LOCATION:
Castleshaw Centre
Waterworks Rd
Delph
OL3 5LZ
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Email *
First name *
Last Name *
Date of birth *
MM
/
DD
/
YYYY
Mobile Number *
Tetanus *
Allergies *
If none please write none
Please notify us of any medical conditions (Physical, mental, dental, optical or other). *
If none please write none
Prescribed medication (must be brought on weekend) *
If none please write none
Paracetamol *
Do you consent to the Habo Madrich/a responsible for first aid on the weekend to provide your child with paracetamol?
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).
Dietary Requirements *
City travelling from (before weekend) *
City traveling to (after weekend) *
Transport
The weekend is held at a residential site in Manchester, all those out of Manchester will have travel booked for them by Habonim Dror. The cost for this transport is included in the cost of the Weekend. An email will be sent two weeks prior to the weekend with final information and confirming details to book.
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