Parental Confirmation Form 2022

Dor Haba Online Parental Permission Form 2022

This form is intended for parents of registered youth for the Dor Haba conference in Netanya from 26-29.6

"*" indicates required fields

The number of children you have registered for the Dor Haba conference:*

One teenager

Two teenagers

Three teenagers

Four teenagers

Five teenagers

Health details (to be filled in by a parent)

Is your child / children covered by health insurance / health insurance?*

(Click on the arrow on the right)

Health Insurance Company*

For all your children who are registered

Emergency Contact Information*

For all your children who are registered

Full Name Relationship to Registrant(s) Telephone Number

Registered son / daughter # 1*

Full Name Israeli ID number (or passport #)

Will the participant take medication during the conference?*

For all your children who are registered*

The participant can take the medication independently

The participant needs a reminder or help from the staff

Is he / she allergic to anything and if so please specify:*

Yes/no and what is he/she allergic to?

Describe the body's response to allergy and treatment

Illnesses or other physical restrictions*

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

Does he / she have any emotional/learning difficulties or diagnoses?*

Such as the autism spectrum, attention and concentration problems, outbursts of anger, etc. Please explain if he/she has certain needs and how we can help when certain circumstances are difficult for him/her.

Registered Son / Daughter # 2

Full Name Israeli ID number (or passport #)

Will the participant take medication during the conference?*

For all your children who are registered

The participant can take the medication independently

The participant needs a reminder or help from the staff

Is he / she allergic to anything and if so please specify:*

Yes/no and what is he/she allergic to?

Describe the body's response to allergy and treatment

Illnesses or other physical restrictions*

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

Does he / she have any emotional/learning difficulties or diagnoses?*

Registered Son / Daughter # 3

Full Name Israeli ID number (or passport #)

Will the participant take medication during the conference?*

For all your children who are registered

The participant can take the medication independently

The participant needs a reminder or help from the staff

Is he / she allergic to anything and if so please specify:*

Yes/no and what is he/she allergic to?

Describe the body's response to allergy and treatment

Illnesses or other physical restrictions*

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

Does he / she have any emotional/learning difficulties or diagnoses?*

Such as the autism spectrum, attention and concentration problems, outbursts of anger, etc. Please explain anything we should know or look out for. Also, in case they have trouble or difficulty, how we can help them during their time at the camp.

Registered Son / Daughter # 4

Full Name Israeli ID number (or passport #)

Will the participant take medication during the conference?*

For all your children who are registered

The participant can take the medication independently

The participant needs a reminder or help from the staff

Is he / she allergic to anything and if so please specify:*

Yes/no and what is he/she allergic to?

Describe the body's response to allergy and treatment

Illnesses or other physical restrictions*

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

Does he / she have any emotional/learning difficulties or diagnoses?*

Registered Son / Daughter # 5

Full Name Israeli ID number (or passport #)

Will the participant take medication during the conference?*

For all your children who are registered*

The participant can take the medication independently

The participant needs a reminder or help from the staff

Is he / she allergic to anything and if so please specify:*

Yes/no and what is he/she allergic to?

Describe the body's response to allergy and treatment

Illnesses or other physical restrictions*

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

Does he / she have any emotional/learning difficulties or diagnoses?*

Such as autism, attention and concentration problems, outbursts of anger, etc. Please explain anything we should know or look out for. Also, in case they have trouble or difficulty, how we can help them during their time at the camp.

Registration fee

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

Yes

How many of your children will be on the ride?

From what city? (back and forth)

The Price of Transportation after Sibling Discount

Payment of registration fee

The Dor Haba conference costs NIS 400 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 from the same family pay only NIS 200 each. If a family is unable to pay the registration fee even after the automatic sponsorship and the Discount for Siblings, additional financial aid can be requested as needed in the registrant's form and/or in this form.

Did you request additional financial assistance (help) in the registration form?*

Yes

Just the Sibling Discount

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

Paypal or credit via Aare you able to pay in advance and online in the BIT mobile app or via credit card with Paypal?*

Due to a large number of registrants, this will help the registration process go much quicker and easier upon their arrival at the conference.

Yes

Please explain

Parental permission

Rules of Conduct*

*Please 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 do not improve after this, they will meet with the Camp Director. If they continue after that, they will be sent home. But for those who do not obey rules 2 or 5, the consequences are immediate and they will be sent home from the conference.

Confirmation from your 1st/only teenager registered:*

"I have read the rules and the implications, I understand them, and I agree to respect them."

Confirmation from your 2nd teenager registered:*

"I have read the rules and the implications, I understand them, and I agree to respect them."

Confirmation from your 3rd teenager registered:*

"I have read the rules and the implications, I understand them, and I agree to respect them."

Confirmation from your 4th teenager registered:*

"I have read the rules and the implications, I understand them, and I agree to respect them."

Confirmation from your 5th teenager registered:*

"I have read the rules and the implications, I understand them, and I agree to respect them."

Confirmation from the parents:*

"We have read the rules and consequences, I have talked about them with my daughter who is about to attend the conference, and I agree to arrange a return home if he / she is told that he / she must leave the conference due to his/her actions or disrespectful behavior (as described in the consequences )."

Permission to participate in the creative project

I give my permission for him/her to participate in the filming of the Creative Project made by the students, a video put to music (a believing song), which will be uploaded to YouTube. Drama and dance students will appear together in the video.

Mother details*

Or legal guardian

Full Name Israeli ID number (or passport #)

Mother's approval*

I allow my child(ren) to participate in the Dor Haba/Jil Sa’ed Youth Camp, hosted by Succat Hallel, at the Nordia Hostel near Netanya from June 26-29, 2022. I realize that this is a Messianic gathering that teaches from the New Testament as well as the Old Testament and that recognizes Yeshua as the Messiah and the Son of God.

Mother's signature*

Details of the father*

Or legal guardian

Full Name Israeli ID number (or passport #)

Father's approval*

Father's signature*

E-mail adress*

to which an e-mail confirmation and other important information will be sent. * Check the Promotions Bin in case the email does not reach your inbox. *

E-mail adress Email address confirmation

Dor Haba 2021 - Youth | Kids

Dor Haba Online Parental Permission Form 2022

Health details (to be filled in by a parent)

Registration fee

Payment of registration fee

Parental permission