Dor Haba 2023 Parental Approval Form

This form is intended for parents of teenage guys/girls registered for the next generation conference taking place in Netanya from July 24th-29th, 2023. *Their registration is not saved until you fill out and send this form.* The content of the targeted form: parental approval and electronic signature, health form, joining the shuttle, discount request and registration fee

"*" indicates required fields

Hidden

Timestamp

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

on a mobile phone via WhatsApp

by e-mail (email address)

Primary Phone*

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

E-mail adress*

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 adress Email address confirmation

The number of your children registered for the Dor Haba/Jil el'Saaed (Rising Generation) 2023 conference*

One teenager

Two teenagers

Three teenagers

Four teenagers

Five teenagers

Registration for transportation

Will your child(ren) participate in the Dor Haba organized transportation?*

Yes

How many of your children join the ride?*

From what city? (back and forth)*

The shuttle costs NIS 50 round trip (regardless of which place of collection) Can be paid intentionally

From where else?*

If there are enough registrants needing transportation from this location, we may arrange transportation from there as well.

Payment of registration fee

The next generation 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. Before May 31, the conference costs NIS 500 per person. Siblings from the same family receive a 50% discount for the first sibling and 25% for additional siblings. If a family is unable to pay the registration fee even after the subsidy and sibling discount, it is possible to apply Additional financial assistance when needed. This year we are asking everyone to pay the full amount or at least an advance, and the rest of the amount up to a week before the event.

Who pays for your child(ren)?

If your congregation/church pays for you, they should contact us as soon as possible, via WhatsApp or email info@dorhaba.com. We will close the payment details with the congregation as soon as they pay the down payment fee (NIS 50 per participant). Then, everyone that is registered will receive a 'congregational payment code' that the parents can specify in the online parent form to complete the registration.

Do you need financial assistance (help) beyond the already existing subsidy?*

Yes

No, just a sibling assumption if applicable

The number of children in your family*

Please enter a number from 1 to 15.

What is your monthly household income?

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)

9,000-11,000 NIS per month ($2500-$3000)

11,000-22,000 NIS per month ($3000-$6000)

22,000-28,000 NIS per month ($6000-$8000)

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.

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

You are eligible for financial aid

Before proceeding, check at the bottom of the page if your request for the desired amount has been approved!

Sorry, but you are not eligible for financial aid

Attention (!) - Please go back to the question "Do you need financial assistance" and choose "No, only siblings allowance if applicable"

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

Is the child/s covered by medical insurance/hospital insurance?*

(Click on the arrow on the right)

Name of the medical insurance company/hospital fund*

to all your children

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.

יש צורך בעזרה/ בתזכורת על-ידי צוות הכנס

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

diseases or other limitations*

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 any emotional or educational diagnosis?*

For example: on the autistic spectrum, attention and concentration, tantrums, etc. Please explain if he/she has certain needs and how we can help during the time of difficulty

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.

יש צורך בעזרה/ בתזכורת על-ידי צוות הכנס

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

diseases or other limitations*

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 any emotional or educational diagnosis?*

For example: on the autistic spectrum, attention and concentration, tantrums, etc. Please explain if he/she has certain needs and how we can help during the time of difficulty

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.

יש צורך בעזרה/ בתזכורת על-ידי צוות הכנס

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

diseases or other limitations*

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 any emotional or educational diagnosis?*

For example: on the autistic spectrum, attention and concentration, tantrums, etc. Please explain if he/she has certain needs and how we can help during the time of difficulty

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.

יש צורך בעזרה/ בתזכורת על-ידי צוות הכנס

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

diseases or other limitations*

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 any emotional or educational diagnosis?*

For example: on the autistic spectrum, attention and concentration, tantrums, etc. Please explain if he/she has certain needs and how we can help during the time of difficulty

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.

יש צורך בעזרה/ בתזכורת על-ידי צוות הכנס

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

diseases or other limitations*

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 any emotional or educational diagnosis?*

For example: on the autistic spectrum, attention and concentration, tantrums, etc. Please explain if he/she has certain needs and how we can help during the time of difficulty

Regulations and rules of conduct at the conference

Rules of Conduct*

Please read the rules of conduct of the conference *together with your child(ren)*. During the conference, if one or the other of them does not respect the rules, he will call for a conversation with two instructors. If after that their attitude and behavior does not change, they will call for a conversation with the conference managers. If after that the attitude and behavior is repeated again, they will be sent home. For those who do not obey rules 2 and/or 5, the consequences are obvious: sending home from the conference

Special permits

Permission to participate in the creative project*

I authorize my child to take part in filming a clip or video that will be produced by film/video production from students at the conference and that will appear on the YouTube channel of "The Next Generation"

Yes

Yes, but not as a main character in the video

Permit for a walk on the boardwalk*

I authorize my son/daughter to participate in a trip on behalf of the conference 'The Rising Generation' to the Netanya promenade, or any other promenade, together and under the supervision of the conference staff on Friday 7/28. It is clear to me that the participants in the drama, music and dance classes will appear in this class.

Yes

Parental permission

Mother details*

Or legal guardian

Full Name Telephone Number Israeli ID number (or passport #)

Mother's signature*

Details of the father*

Or legal guardian

Full Name Telephone Number Israeli ID number (or passport #)

Father's signature*

Community payment code*

We will close the payment details with the congregation/church. They must contact us as soon as possible, via WhatsApp or email, and as soon as they pay the advance fee (NIS 50 per participant), then each registrant will receive a 'community payment code' to complete the registration.

registration amount

For a boy/girl before May 31st

Price:

Registration amount with sibling discount

Registration of two boys before May 31 (500+250)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of three boys before May 31 (500 + 250 +375)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of four boys before May 31 (500 + 250 +375 + 375)

Price: ₪ 0.00

Registration amount with sibling discount

Registration of five/five boys/girls before May 31st (500 + 250 +375 + 375 + 375)

Price: ₪ 0.00

transportation

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 450

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 400

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 350

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 300

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 250

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 200

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 150

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 100

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 50

Price: ₪ 0.00

Your request for financial aid has been approved!

Registration fee per child - 0

Price: ₪ 0.00

I am able to pay now with credit..

Because of the large number of registrants it will greatly facilitate you The registration process upon arrival at the conference if you pay in cash or by credit **In case of cancellation, for any reason, you will receive the registration fee back, except for the advance fee, immediately and through the 'Bit' application. *In case of cancellation due to illness or a family emergency before and during the conference, a full refund, including the advance fee, will be given immediately and through the 'Bit' app.

Please explain

down payment only for all registered child(ren).

The rest of the amount can be paid on credit up to a week before the conference. If you have not paid the entire registration amount until one week before the conference, your registration will be cancelled

Price: ₪ 100.00

Total