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UJIA Israel Experience Form II

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UJIA Israel Experience Full Application Form

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Before you start please make sure to refer to the Full Application Guide that you received in the email. Please note the deadline to submit this form (Full Application) is Monday 10 February 2025.

You have 4 weeks from today to complete Form II, unless that date falls later than Monday 10th February 2025 which is the final deadline for Form II. All application forms will close after this date.

This form is unique to each applicant and includes pre-filled information. Please do not continue with this form if the applicant's name on page 2 is not the person you are applying for. If you are applying for multiple siblings, please make sure to use the unique link you received by email for each child.

All questions on this form are regarding the young person applying to go on Israel Tour. However, it is the Parent/Guardian’s responsibility to complete this form on their behalf. 

If you are applying to be a Madrich/a (Leader) for Israel Tour, please complete the form on your own behalf.





Applicant Information & Passport



DD/MM/YYYY



Applicant Contact Details



Applicant Address Information





Applicant Passport Information

Please Note: all Participant passports must be valid for 6 months after their return date from Israel - it is your responsibility to ensure the participant has a valid passport.


Yes No
Passport Details


DD/MM/YYYY


DD/MM/YYYY

Please ensure that this is a clear photo.
Yes No
Other Passport


DD/MM/YYYY


DD/MM/YYYY

Please upload a general picture of the applicant, where there applicant is identifiable.
ETA Requirement
From 1 January 2025, to visit Israel you will need to obtain an Electronic Travel Authorisation (ETA) before you arrive. The ETA covers a visit of 90 days and will cost 25 New Israeli Sheqel. You can check your eligibility and apply for an ETA with the Israel Population and Immigration authority here:  
ETA-IL
Please make sure you apply for an ETA if required with plenty of time before departure. Please contact your youth movement if you have any questions about this process.

If you need to obtain a new passport, please do so IMMEDIATELY as this can take considerable time, particularly in the run up to the summer. If this is the case, answer "no" to the question below and continue with the form. It is essential that you email your Youth Movement/Organisation with your new passport information as soon as it is received.

Please Note: if the Applicant has an Israeli Passport it is your responsibility to address all relevant entry and exit requirements - if any delays or complications arise it will be wholly your responsibility.


Parent/Guardian #1 Information















In case of an emergency, the organisers may need to take legal responsibility and act in loco parentis. Please click here and make sure to download the in loco parentis document for you to sign.

Yes No

Yes No
Yes No

Parent/Guardian #2 Information






Parent/Guardian #2 Address Information









Yes No

Emergency Contact Person in the UK


While the Applicant is on Israel Tour, it is important that UJIA Israel Experience and your Youth Movement/Organisation should be able to contact a responsible adult at any time, should the Parent/Guardian(s) be unavailable. This person should be contactable by phone/email at any point throughout Israel Tour and should be prepared to take responsibility for the Applicant should they need to return home. Please inform this person of the above and ensure that they are aware of the dates of Israel Tour and that in an emergency they will be contacted during unsociable hours.








Yes No
Yes No

Emergency Contact Person in Israel

While the Applicant is on Israel Tour, it is important that UJIA Israel Experience and your Youth Movement/Organisation should be able to contact a responsible adult at any time, should the Parent/Guardian(s) be unavailable. This person should be contactable by phone/email at any point throughout Israel Tour and should be prepared to take responsibility for the Applicant should they need to leave the programme. Please inform this person of the above and ensure that they are aware of the dates of Israel Tour and that in an emergency they will be contacted during unsociable hours.

Please give details of someone based in Israel who can be contacted in case of emergency. 
Please inform them that they have been nominated on this form.






Yes No
Yes No

General Information


This is for research and programme management purposes. Your Youth Movement/Organisation may contact your school or synagogue for a personal reference. Some Youth Movements may prioritise places for members of specific synagogues/streams of Judaism. For more information, please contact your Youth Movement/Organisation directly.

This is for research and programme management purposes. Your Youth Movement/Organisation may contact your school or shul for a personal reference.


Synagogue


Shul

Stream of Judaism


Friends
We spend a lot of time ensuring that all of our Tours are balanced and we look to meet the needs of all of our Participants. If you wish, please name a maximum of three friends with whom you would like to be grouped for Israel Tour.
We will do our best to accommodate one of your choices, however please note that we make no guarantees and we also take into account social and behavioral issues.
Please note that the names listed are not in priority order. Group splits will only be made based on those preferences submitted online.

Please ensure that you write the full names of the friends with whom you are requesting to be grouped.

If this field is left blank, we will take it that you have no preferences.

If there are any social issues of which the Youth Movement/Organisation should be aware of, please also contact them directly to discuss.
Friend Friend  Friend
Miscellaneous





Applicant Additional Information

DD/MM/YYYY

DD/MM/YYYY


DD/MM/YYYY

DD/MM/YYYY


Yes No

Yes No

Yes No

Yes No









Yes No

Dietary/Allergies & Additional Information


Disclosing full and complete information regarding allergies is extremely important so that the Youth Movement/Organisation and the Service Provider in Israel can fully understand the needs of the Applicant.

The Organisers are unable to make any guarantees or commitments regarding allergy triggers.

As a reminder, any Applicant that has been prescribed an adrenaline auto-injector (EpiPen) should bring a minimum of two EpiPens on Israel Tour. Both of these two EpiPens should be kept on the Applicant at all times in an appropriately marked (name, triggers etc) protective box. If an EpiPen is used, lost, damaged or stolen it must be replaced in Israel at the family's expense as it will not be covered by the medical insurance.
Yes No
Allergy requirements

These questions should be answered where you have any allergy or intolerance diagnosed by a healthcare provider (including those indicated in the previous question and also including both food and non-food allergies e.g. animals, stings, medications, latex, etc.). If you have been given an allergy management protocol document by a medical practitioner, please provide a copy of this.

You will have the opportunity to provide us with details of up to 3 allergies. If you have more, please select “other allergies” and make sure to list them all in the description box.
Allergy Allergy Level Age of Applicant at original diagnosis Allergic reaction is triggered


Common symptoms - Skin: hives, itching, rash, flushing, swelling (face, arms, hands, legs). Mouth: itching, swelling (lips, tongue, mouth). Abdominal: nausea, cramps, vomiting, diarrhoea. Throat: itching, tightness, difficulty swallowing, hoarseness, cough. Lungs: shortness of breath, repetitive cough, wheezing, tightness of the chest. Heart: chest pain, loss of consciousness.


Please include information regarding medication (name, frequency and dosage) as well as other treatments for the condition. If the Applicant has a diagnosis but has never had a reaction, please indicate this and provide information regarding treatment and medication recommended by a healthcare provider for use in case of an allergic reaction.

N/A Yes No
Yes  No
Yes No
I agree
All Applicants with an allergy must fully complete the Allergy questions on the Online Application Form so that the Youth Movement/Organisation can fully understand the specific needs of each Applicant prior to Israel Tour, which, in the large majority of cases, the Tour Provider in Israel is able to cater for. 

In Israel, food allergies are less common than in the UK, especially with regards to nut, sesame and chickpea allergies. Consequently we are unable to provide food suppliers, restaurants or accommodation sites in Israel that can guarantee that food has been made in a nut free environment, or guarantee that specific foods have not been present in the preparation of a dish. Alongside this, many snacks (including chocolate and crisps) contain nuts/sesame/chickpeas which means the presence of these are to be found throughout Israel including in kitchens.

Please note, El Al have not been able to guarantee the absence of nuts/sesame/chickpeas in the in-flight meals on the plane and most El Al meals contain one of these food products which means that they will not make an announcement to passengers to refrain from eating these products. In addition, El Al does not offer a vegetarian allergy meal.

Therefore, it is essential for you to provide us with very specific information relating to any food allergy (including whether reaction occurs with airborne food particles) to make us aware of the possible risks in addition to signing the waiver below. As a reminder, if you have been prescribed an adrenaline auto-injector (EpiPen) you should bring a minimum of two doses on Israel Tour. Both of these two doses should be kept on the Applicant at all times in an appropriately marked (name, triggers etc) protective box. If an EpiPen is used, lost, damaged or stolen it must be replaced in Israel at the family's expense as it will not be covered by the medical insurance.

Please note that ingredients lists in Israel are likely to be written in Hebrew and the Applicant should ensure they fully understand what they are consuming before doing so.
Dietary/ Intolerance requirements

To select multiple options, press and hold ‘ctrl

El-AL Meals Selection


Elal will only offer the above meals, and cannot offer any other meals/ combinations of meals other than the ones on this list .

Medical Conditions

We take equality and inclusion very seriously and do our upmost to accommodate all manner of health and welfare issues. Disclosing your needs to us well in advance allows us to cater for your child/participant's needs during Israel Tour and create a suitable care plan. However, if we are unaware of issues beforehand, we may be unable to provide the required level of support during Israel Tour, resulting in your child/participant having to be removed from the programme for their safety, and at your expense.
Doctor/General Practitioner




Over the past six months:
None Yes




Depending on the severity of the condition(s), you may be required to provide additional information and/or documentation. It is likely that this will need to be written by a Doctor/Specialist/Consultant/other medical professional as required. In cases where a medical practitioner is required to provide such documentation, they will need to be provided with a description of the Israel Tour Programme provided by the Organisers and be asked for details of: the condition, limitations to your ability to participate in the Programme and its sub-parts, frequency of medication and treatment, together with their contact details. (Please note, this information will also be used to ensure that insurance and appropriate care can be provided.)

In order to ensure that the Application process is completed as efficiently as possible, and by the relevant deadlines, we recommend that you alert the Doctor/Specialist/Consultant/other medical professional as soon as possible that this may be required of them in order for you to participate on Israel Tour.

More than six months ago:
None Yes




Depending on the severity of the condition(s), you may be required to provide additional information and/or documentation. It is likely that this will need to be written by a Doctor/Specialist/Consultant/other medicial professional as required. In cases where a medical practitioner is required to provide such documentation, they will need to be provided with a description of the Israel Tour Programme and be asked for details of: the condition, limitations to your ability to participate in the Programme and its sub-parts, frequency of medication and treatment, together with their contact details. (Please note, this information will also be used to ensure that insurance and appropriate care can be provided.)

In order to ensure that the Application process is completed as efficiently as possible, we recommend that you alert the Doctor/Specialist/Consultant/or other medical professional as soon as possible that this may be required of them in order for you to participate in Israel Tour.

Medication, Medical Information & Immunisations

Yes No

Please note: you are responsible for managing and monitoring the administration of your own medication. The Madrichim (Leaders) are not medically trained and the groups are accompanied by a First Aider who is not qualified to manage prescription medication.



Additional comments on your current state of health (including all aspects of health and well-being):

Yes No

Yes No

Please include dates and time-frames of how long it took for you to recover, medication that was taken, ongoing treatment and whether it will have any impact on your ability to fully participate in the Israel Tour Programme.
Yes No

For each condition please include: Name of Condition, dates experienced this condition (start & end), severity, treatment, medication, likelihood of recurrence on Israel Tour, stability of condition over the past 6 months (this is crucial for the medical insurers)

Immunisations

You are responsible for and required to ensure that the Participant obtains any required and recommended immunisations at the appropriate time prior to departure. We understand that good general practice requires all people to have had the appropriate immunisations for Polio, Meningitis and Tetanus and we strongly encourage all Israel Tour Applicants and Madrichim to follow this guidance. Therefore, all Israel Tour Applicants and Madrichim are understood to have had these immunisations. Where this is not the case, you will be held wholly responsible for any consequences and for any associated costs – treatment, travel, hospitalisation, repatriation, et al - for any illness or infection contracted on Israel Tour where prior immunisation may reasonably have been expected to protect against the condition (it may also impact on insurance cover).

Should the Participant not have had a Tetanus booster within the last 10 years prior to the commencement of Israel Tour and they contract an illness or infection as a result, costs, including but not limited to the administration of a Tetanus injection should it be required, internal travel in Israel, hospitalisation, treatment and a return flight, will not be covered by the Insurance Policy. You will be responsible for any and all costs incurred for any treatment received as a result of this. We will rely on information supplied on this Medical Form relating to these matters.

Should circumstances arise, the Israeli Medical Authorities will administer a Tetanus injection as they deem to be appropriate and following Israeli medical protocol. 

You can find out more information on the required and recommended Health Formalities in Israel by speaking to your GP or by searching travel health websites (the Israeli Health Ministry website may also be useful).
Yes No Not known



Please note, your GP will be asked to confirm the above on the GP Medical Form. A ‘Not Known’ will be treated as a ‘No’, and the conditions highlighted in the second paragraph above in this section will apply.

Well-being/ Self-Harm

Please be in touch with your Youth Movement/ Organisation if there are any social/ welfare issues that may affect the groups split.

Eg: Anything that has occurred in the last ten years that you think would be useful for us to know including emotional stress, illness, divorce or bereavement
Yes No

Please include start and end date of therapy (or indicate that it is ongoing), frequency of appointments as well as the reason(s) for attending. If you have had more than one course of counselling/psychotherapy/psychological/psychiatric etc. please provide dates and causes for each course individually.

If you have received any form of counselling, psychotherapy, psychological or psychiatric treatment etc. we may require an accompanying Mental Health Form, which your Youth Movement/Organisation will provide where necessary, to be completed by a Counsellor/Doctor/Specialist. The form includes a description of the Israel Tour Programme and asks for details of the condition, limitations on and capablities of the Applicant's participation in the Programme and its sub-parts, frequency of medication and treatment together with the Counsellor/Doctor/Specialist's contact details.

Please note, an additional letter may still be required from the Counsellor/Doctor/Specialist if the medical insurers require further information not provided on the form.

In order to ensure that the Application process is completed as efficiently as possible, and by the relevant deadlines, we recommend that you alert the Counsellor/Doctor/Specialist as soon as possible that this may/will be required of them in order for you to participate in ”Israel Tour” - and by the relevant deadlines.
Yes No

Fears & Phobias
Yes No

Self-Harm

Self-Harm refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act, and is an expression of emotional distress (National Institute for Clinical Excellence, 2020). It includes all forms of deliberate behaviour which damage your body in any way either internally or externally, including cutting or burning yourself (or causing damage to your mental state of health or well-being).
Yes No

GP Form Uploads

Coronavirus (COVID-19)



For up-to-date information and guidance on Entry of Non-Israeli Citizens by Air into Israel please refer to the Ministry of Health guidance page click here
If so, when?














GP Medical Form
You have a few options to complete your Medical Sign Off Form. 

- Either by taking the GP form below to your local GP (usually £30-50). More details of this process can be found on the GP form.- Use the service provided by JDoc365 at a cost of approximately £50

Or you can decide to use the service provided by
- JDoc365 at a cost of £50
- ZoomDoc at a cost of £50


Click here to find out how to complete this process through JDoc365/ ZoomDoc. 


You can download the GP Medical Form here.

 
Once the Medical Sign Off Form has been completed, stamped and signed by your GP or JDoc365/ ZoomDoc, please upload it here. If you are unable to do so, please either email or post it to your Youth Movement/Organisation directly as soon as it has been completed, with the name of the Applicant clearly marked for reference. If the online upload is not clear enough for us to read, we will be in touch to ask for another copy or the original via post so please retain the original for your records. If you do not retain the original and we require an additional copy, then a new Form will need to be completed again by the GP or JDoc365/ ZoomDoc at the further expense of the Parent/Guardian. Your Youth Movement or Organisation will not process your Application until they have received your Medical Sign Off Form.
GP Medical Form Madrich/a
You have a few options to complete your Medical Sign Off Form. 

- Either by taking the GP form below to your local GP (usually £30-50). More details of this process can be found on the GP form.- Use the service provided by JDoc365 at a cost of approximately £50

Or you can decide to use the service provided by
- JDoc365 at a cost of £50
- ZoomDoc at a cost of £50


Click here to find out how to complete this process through JDoc365/ ZoomDoc. 


You can download the GP Medical Form here.

 
Once the Medical Sign Off Form has been completed, stamped and signed by your GP or JDoc365/ ZoomDoc, please upload it here. If you are unable to do so, please either email or post it to your Youth Movement/Organisation directly as soon as it has been completed, with the name of the Applicant clearly marked for reference. If the online upload is not clear enough for us to read, we will be in touch to ask for another copy or the original via post so please retain the original for your records. If you do not retain the original and we require an additional copy, then a new Form will need to be completed again by the GP or JDoc365/ ZoomDoc at the further expense of the Parent/Guardian. Your Youth Movement or Organisation will not process your Application until they have received your Medical Sign Off Form.

Please upload the Medical Form
Specialist Form & Letter (if applicable)
If the applicant is being treated by a Specialist for a physical and/or mental condition, please upload the Specialist’s form and supporting letter here:


You can download the Specialist Form & Letter here.

Permissions and Contact Preferences

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Declaration

We appreciate your honesty in disclosing the Applicant’s medical history. The Youth Movement/Organisation, UJIA, UJIA Israel Experience, JAFI and Tour Provider, (The Organisers), aim to create supportive and inclusive environments for all Participants on Israel Tour so that they may get the most out of the trip.

Whilst we, the Organisers, will do our upmost to support the Applicant, there is still a risk that they may experience mental health conditions on Israel Tour. The Applicant’s health and well-being during the Programme is our primary concern. Therefore, the Organisers have outlined how we may best support the Applicant during Israel Tour which may include a Support Plan and a Risk Assessment. It should be noted that the Applicant’s acceptance on to the Programme and ongoing participation is at the sole discretion of the Organisers.

The majority of medical insurance policies for Israel Tour do not cover any self-inflicted medical situations or psychological treatment/assessment related to mental health conditions. If the Applicant experiences mental health conditions during Israel Tour and the Organisers decide that they require medical or psychological treatment/assessment for their safety and well-being, this will not be covered by the insurance policy. Therefore, all associated costs will be at the Parent/Guardian’s expense. You can find further explanation of this in the Important Information Booklet and the Terms and Conditions of the Programme.

It is important to note that, due to the nature of the Programme, the Madrichim (Leaders) will not be with the Chanichim (Participants) at all times, including, but not limited to free time, when the group are at their accommodation, at night and when using the bathroom.

During Israel Tour, should the Applicant need additional support, they must speak to one of their Madrichim (Leaders) so that they can best understand how to support them. This may be as per their Care Plan, as agreed with you in advance, or through treatment from medical professionals in Israel, if the Organisers decide that this is required.

As stated above, as the Applicant’s Parent/Guardian(s):
• I acknowledge the medical insurance policy for Israel Tour does not cover any self-inflicted medical situations or psychological treatment/assessment related to mental health conditions.
• I understand that I will be liable for any and all associated costs relating to any required treatment.
• I understand that The Organisers reserve the right to remove an Applicant from the Programme if The Organisers decide that there is concern for their safety and well-being and/or if the required level of support is beyond which can be reasonably provided and/or if their needs are impacting negatively on the group dynamics.
• If the Applicant has to return to the UK at an alternative time for any reasons relating to their mental health, repatriation will not be covered by the Israel Tour medical or travel insurance and any associated costs will be covered by myself, the Parent/Guardian(s).
• I confirm that I have fully disclosed all of the Applicant’s medical history relating to their mental health to The Organisers, including all information relating to severity, symptoms and previous treatment.
• I agree that I will continue to update the Youth Movement/Organisation if there are any changes to the Applicant’s mental, emotional or physical health prior to Israel Tour. As part of this, I agree to comply with any requests from the Youth Movement/Organisation for an update from any professional involved with the Applicant’s care at any time. I agree that if this is required, any costs will be at my expense as their Parent/Guardian(s).

FZY Miscellaneous Information

FZY and the Friends of FZY
Yes No

Yes No



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