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                                                                   Medical Form


Full name______________

tel.________________     Mobile______________________     Home phone_______________________

I.D./Passport no._________________


Medical insurance details

My daughter does not suffer from any illnesses.

My daughter suffers from__________________



If she has any medical problem you must send a full medical form signed by your doctor.

We give our daughter _______________________  permission to participate in all camp activities.

We will be responsible to pay for any medicines or medical treatment our daughter might need during the camp.


She knows how to swim and we allow her to join swimming activities in camp.
She does not know how to swim .

We give our permission to use photographs of our daughter that were taken during camp on Machane Hineni's website or for promoting camp.


Parent's name________________________Parent's signature________________


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