Dor Haba Parental Permission Form 2024

This form is intended for parents of teenagers, and 18-year-old participants, who would like to register for the Dor Haba conference taking place in Netanya during 28.07-02.08.2024. *In order to complete your registration this form must be filled out and submitted and the registration fee must be paid in full. In the online form you will find: parental consent and electronic signature (18-year-olds will sign for themselves), health declaration, request to join the transportation, financial aid request and payment of registration fee. If your congregation is paying for you, have them contact us as soon as possible, via WhatsApp or email info@dorhaba.com.

"*" indicates required fields

Who is filling out this form?*

Fill out this form only after all of your children have filled out a registration form

Who pays for your child(ren)?*

For the 18-year-olds, who is paying for you?

Congregation/Church payment code

If the *congregation* pays for you/your children, you must ask the community representative to contact us via WhatsApp or email. Only *after* your congregation pays the registration fee in full, for each registrant, they will receive a 'congregation payment code'. Please enter this code here. info@dorhaba.com

Number of children registered to come to Dor Haba:*

18-year-olds please choose the first option

One teenager

2 teenagers

3 teenagers

4 teenagers

5 teenagers

A preferred method for calling and receiving important information*

We are opening a WhatsApp group for parents and we would love for you to join it

By phone through whatsapp

by e-mail (email address)

Primary Phone*

This number will be added to the parent WhatsApp group, to which important information about the conference will be sent

E-mail Address*

This address will be added to the conference mailing list, to which important information regarding the conference will be sent Please note, sometimes the mail will go directly to the spam or advertisements box

E-mail Address Email address confirmation

Before you filll out the form - please note

Health details - to be filled out by a parent only!

18-year-olds - to be filled out by you

Name of Israeli Cupat Holim OR Other Health Insurance*

If not, please purchace health coverage for them while they are at the camp.

Please indicate the name of the insurance company and the policy number*

Additional emergency contact (if primary parent is unavailable)*

to all your children

Full Name Proximity to registrants Telephone Number

Details of registrant #1*

Full Name Israeli ID number (or passport #)

Does the participant need to take medication during the conference?*

If so, should he/she be helped to do so?*

There is no need for help/reminding. They can take it independently.

Will he/she need reminders or help to take his/her medicine.

Does your child need an EpiPen?*

If so, it should be brought to the conference and kept close to the child at all times.

Is the child allergic to anything? please specify*

Please answer yes or no, if so - what is the allergy/sensitivity?

Describe the body's reaction to the allergy and the required treatment

As much information as possible will help us to keep your child safe during the conference

Illnesses or Disabilities*

Please list and explain any illness or medical and/or dietary restriction, if any. For example: diabetes, anemia, gluten allergy, celiac disease, lactose intolerance etc.

Does the child have a mental health diagnosis or a learning disability?*

For example: on the autistic spectrum, diagnosed attention deficit hyperactivity disorder, anger outbursts, depression or unstable mental state, etc. Please explain if he/she has certain needs and how we can help when they are having a difficult time

Details of registrant #2

Full Name Israeli ID number (or passport #)

Does the participant need to take medication during the conference?*

If so, should he/she be helped to do so?

There is no need for help/reminding. They can take it independently.

Will he/she need reminders or help to take his/her medicine.

Does your child need an EpiPen?*

If so, it should be brought to the conference and kept close to the child at all times.

Is the child allergic to anything? please specify*

Please answer yes or no, if so - what is the allergy/sensitivity?

Describe the body's reaction to the allergy and the required treatment

As much information as possible will help us to keep your child safe during the conference

Illnesses or Disabilities*

Please list and explain any illness or medical and/or nutritional limitation, if any: For example: diabetes, anemia, gluten allergy, celiac disease, lactose intolerance etc.

Does the child have a mental health diagnosis or a learning disability?*

Details of registrant #3

Full Name Israeli ID number (or passport #)

Does the participant need to take medication during the conference?*

If so, should he/she be helped to do so?

There is no need for help/reminding. They can take it independently.

Will he/she need reminders or help to take his/her medicine.

Does your child need an EpiPen?*

If so, it should be brought to the conference and kept close to the child at all times.

Is the child allergic to anything? please specify*

Please answer yes or no, if so - what is the allergy/sensitivity?

Describe the body's reaction to the allergy and the required treatment

As much information as possible will help us to keep your child safe during the conference

Illnesses or Disabilities*

Please list and explain any illness or medical and/or nutritional limitation, if any: For example: diabetes, anemia, gluten allergy, celiac disease, lactose intolerance etc.

Does the child have a mental health diagnosis or a learning disability?*

Details of registrant #4

Full Name Israeli ID number (or passport #)

Does the participant need to take medication during the conference?*

If so, should he/she be helped to do so?

There is no need for help/reminding. They can take it independently.

Will he/she need reminders or help to take his/her medicine.

Does your child need an EpiPen?*

If so, it should be brought to the conference and kept close to the child at all times.

Is the child allergic to anything? please specify*

Please answer yes or no, if so - what is the allergy/sensitivity?

Describe the body's reaction to the allergy and the required treatment

As much information as possible will help us to keep your child safe during the conference

Illnesses or Disabilities*

Please list and explain any illness or medical and/or nutritional limitation, if any: For example: diabetes, anemia, gluten allergy, celiac disease, lactose intolerance etc.

Does the child have a mental health diagnosis or a learning disability?*

Details of registrant #5

Full Name Israeli ID number (or passport #)

Does the participant need to take medication during the conference?*

If so, should he/she be helped to do so?*

There is no need for help/reminding. They can take it independently.

Will he/she need reminders or help to take his/her medicine.

Does your child need an EpiPen?*

If so, it should be brought to the conference and kept close to the child at all times.

Is the child allergic to anything? please specify*

Please answer yes or no, if so - what is the allergy/sensitivity?

Describe the body's reaction to the allergy and the required treatment

As much information as possible will help us to keep your child safe during the conference

Illnesses or Disabilities*

Please list and explain any illness or medical and/or nutritional limitation, if any: For example: low blood sugar, gluten sensitivity, celiac disease, lactose sensitivity, etc.

Does the child have a mental health diagnosis or a learning disability?*

Regulations and rules of conduct at the conference

Rules of Conduct*

You must read the rules of conduct of the conference *together with your child/ren* If someone is found not honoring the rules, they will meet with two leaders and be given a second chance. If their attitude and behavior does not improve after this, they will meet with the conference organizers. If after this they continue the bad behavior, they will be sent home, in coordination with the parents, at their expense and without refund of the registration fee. However, if one of the first two rules are broken, they will sent home immediately with no second chances, in coordination with the parents, at their expense and without refund of the registration fee.

Special permits

Permission to participate in the creative project*

I authorize my child to appear in the music video with everyone at the conference and in other creative videos that may be produced during the conference that will be posted on Dor Haba's Youtube channel

Yes

Yes, but not as a main character in the video

Permission to go to the boardwalk*

I give my son/daughter permission to perfom their creative project on the boardwalk in Netanya if it is relevent to their project. I understand that half of the creative projects will be going to the boardwalk in Netanya, under staff supervision, on Thursday 08.01.24

Yes

Parental permission

Marital Status*

Please note, in the case of divorced parents, both parents must still sign the form!

Mother details*

Or legal guardian

First Name Last Name Telephone Number ID

Mother's signature*

Details of the father*

Or legal guardian

First Name Last Name Telephone Number Israeli ID number (or passport #)

Father's signature*

Registration for transportation

Will your child/ren be joining the bus ride provided by Dor Haba?*

18-year-olds, will you join the bus ride?

Yes

How many of your children will join the bus ride?*

The shuttle costs 50 NIS round trip per child, regardless of the pick-up location or if they only need to travel one way. The amount will be added to the final cost. There is no discount for the transportation fee. 18-year-olds please choose the first option

From what city? (There and back)*

The list of pick-up locations is not final. An updated list will be sent closer to the date of the conference. The cost is in addition to the registration fee (no discount for siblings/financial status/one way)

From where else?*

If there are enough registrants who need transportation from this location, we may arrange a bus ride from there as well. We will update you.

If we cannot arrange a bus ride from the city you have chosen, in which city will you join the transportation? (There and back)*

Payment of registration fee

The Dor Haba conference costs NIS 600 per registrant. This price is what is left AFTER an automatic (discount) of 70% of the actual cost, provided to each registrant by funds raised through Dor Haba. Siblings receive a 25% discount for the first sibling and a 50% discount for all additional siblings. If you cannot pay the registration fee even after the subsidy and sibling discount, you can apply for additional financial aid.

registration amount

Price:

Registration amount with sibling discount

Restration of 2 teenagers (600+450)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of 3 teenagers (600 + 450 +300)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of 4 teenagers (600 + 450 +300 + 300)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of 5 teenagers (600 + 450 +300 + 300 + 300)

Price: ₪ 0.00

Transportation Fee

There is no sibling discount on the transportation fee. The transportation cost remains fixed even if only one direction is needed

Price: ₪ 0.00

Do you need financial aid beyond the subsidy and the sibling discount?*

Yes

What is your monthly household income?*

If your household income is over NIS 9,000, you are not entitled to financial aid

2,000-3,500 NIS per month ($500-$1000)

3,500-5,500 NIS per month ($1000-$1500)

5,500-9,000 NIS per month ($1500-$2500)

How much is your family able to pay for each child?*

The last payslip of each working parent

If the payslips of working parents do not match the household income statement, the entitlement to the discount will be cancelled.

Drop files here or

Max. file size: 300 MB.

The number of children in your family*

Please enter a number from 1 to 15.