2024 Fed Camp Mads Step 1 of 6 16% This field is hidden when viewing the formThis form is currently not accepting new signupsIf you have any questions please speak with the Rosh Machane at camp@bneiakiva.com.au. If you have been provided a code to continue signup, please enter it here.This field is hidden when viewing the formSignup CodeMad Name(Required) First Last Mad Mobile Number(Required)Mad Email(Required) Enter Email Confirm Email State of Residence(Required)NSWVICWANew ZealandYear Level(Required)What year level do you take? Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Other Mad DetailsAs part of the signups, you will need to provide the following medical information. For security reasons, this data is not able to be autosaved whilst it is being entered it in. Progress will only be saved at the completion of this section, when you press Add Mad. We recommend completing this part in one session.Medical details: Medicare number Private Healthcare details Allergy information (including management plans) Asthma information (including management plans) Medical information (including management plans) Date of last tetanus Dietary requirementsIf you do not have this information onhand, we recommend getting this information ready before signing up.Mad Details Row ID Child’s Name Year Level Tuckshop Prepaid Account Camp Price Actions Edit Delete Add Mad Maximum number of mads reached. Family Doctor(Required)Family Doctor Phone(Required) Transportation & AccomodationFor Melbourne Mads. If you are not a Melbourne mad, go back to page one – you probably set the wrong snif.Access to a car(Required)If you have access to a car and are able to assist with mad transport around Melbourne please let us know here. Ensure you factor in luggage. Yes! I can help transport No, I can’t help Car Spots(Required)1234567Able to host(Required)If you have are able to host (have people sleep at your house) on the Monday (16th December), please let us know here. Yes! I can help host No, I can’t help Hosting Spots(Required)1234567Transportation & AccomodationFor Sydney and Perth Mads. If this isn’t you, go back to page one – you probably set the wrong snif.Accomodation(Required)Do you need accommodation on Monday night (16th December)? Yes, please organise my accommodation No, I’ve organised my own accommodation Emergency ContactsEmergency Contact 1 Name(Required)Emergency Contact 1 Relationship to Participant(s)(Required)MotherFatherGrandparentStep-parentLegal guardianCousinOtherEmergency Contact 1 Phone(Required)Alternative Contact Name(Required)Alternative Contact Relationship to Participant(s)(Required)MotherFatherGrandparentStep-parentLegal guardianCousinOtherAlternative Contact Phone(Required) DonationIn our incredible Australian Jewish community, there are unfortunately many families who are unable to afford the cost of camp. It is our priority at Bnei Akiva to make camp accessible to every child aiding them in their personal growth and Jewish development. However this commitment comes at a significant financial burden for Bnei Akiva. We therefore ask that you consider making a donation towards this fund which is directed exclusively towards providing for those children who may otherwise be unable to attend camp. We thank you for your consideration and generosity. Tuckshop Total(Required) Price: $ 0.00 PaymentDiscount Code Total This field is hidden when viewing the formTotalAsNumberForCLCredit Card(Required) MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name
