Machaneh Bonim b'Mexico 2024 Application
Welcome to the MBM 2024 Application! Once you click "next page," your entries from the previous pages will save. If you must stop and come back to your form, please keep your personalized URL from the email sent to you. You will need this URL to come back to your application (so you don't have to start over). If you have any questions, please contact roshmbm@habonimdror.org. Please complete this application by April 29, 2024. If you submit this application after April 29, 2024, you may incur additional fees due to late bookings.
Applicant Full Name (as it appears on passport)
*
First Name
Middle Name
Last Name
Preferred Name
Which Camp did you attend
*
Galil
Gesher
Gilboa
Miriam
Moshava
Tavor
Has never attended HDNA camp
If you have not previously attended an HDNA camp, how did you hear about MBI?
Applicant Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Year
Applicant E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Applicant Cell Phone Number
*
-
Area Code
Phone Number
Assigned Sex (for insurance purposes)
*
female
male
intersex
X
Gender & Pronouns
*
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Parent/Guardian Information
Parent/Guardian 1 Name
*
First Name
Last Name
Parent/Guardian 1 E-mail
*
Parent/Guardian 1 Cell Phone Number
*
-
Area Code
Phone Number
Parent/Guardian 1 Home Phone Number
-
Area Code
Phone Number
Parent/Guardian 1 Work Phone Number
-
Area Code
Phone Number
Parent/Guardian 2 Name
First Name
Last Name
Parent/Guardian 2 E-mail
Parent/Guardian 2 Cell Phone Number
-
Area Code
Phone Number
Parent/Guardian 2 Home Phone Number
-
Area Code
Phone Number
Parent/Guardian 2 Work Phone Number
-
Area Code
Phone Number
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Medical Information
Please select all conditions that apply to the participant:
*
Asthma
Back Problems
Dizziness
Deaf/Hard of Hearing
Fainting
Gastrointestinal Issues
Glasses or Contacts
Head Injury or Concussion
Heart Problems
Orthodontics (current)
Seizures
Sleep Problems
Sleep Walking
None of the above
Other
Please elaborate on any of the selected conditions above:
*
Write N/A if this does not apply to the participant.
Please select all mental health conditions that apply to the participant:
*
ADHD
Alcohol or Drug Abuse
Anxiety
ASD
Depression
Disordered Eating
OCD
Self Harm
Suicidal Idiation
None of the above
Other
Please elaborate on any of the selected conditions above:
*
Let us know if you would rather discuss this on a phone or video call.
Does your child take any medications?
*
Yes
No
If yes, please list them below
*
Anything else about the participant's health that is important for us to know?
Food Allergies & Preferences
Food Allergies
*
Tree nuts
Peanuts
Dairy
Eggs
Fish
Wheat
Sesame
Shellfish
Soy
None of the above
Other
For all allergies listed, please indicate the reaction, severity and how it is treated
*
Dietary Restrictions
*
Vegetarian
Vegan
Kosher
Pescatarian
Lactose Intolerant
Gluten Free
None of the above
Other
Anything else we should know about the participant's dietary needs?
*
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Bus Request
In the case that we have more than one bus, we ask you to tell us 3 people with whom you would like to be on the same bus. We do not guarantee that you will be with the person/people you request, but we will do our best.
Bus Request 1 (full name)
Bus Request 2 (full name)
Bus Request 3 (full name)
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Travel Information
The dates of MBM are July 17 to August 5, 2024. The cost of flights to and from the three travel hubs (YVR, LAX and JFK) are included in the price of MBM. HDNA will book roundtrip travel for the travel hub that you select. If you require a flight deviation, reach out to us immediately, and please be aware that you will be responsible for any additional costs.
Do you have a valid passport that expires after March 4, 2025?
*
Yes
No
Name as it appears on your Passport
*
First Name
Middle Name
Last Name
Passport Number
*
Country passport is issued from
*
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Travel Hub
*
YVR
LAX
JFK
Please list the city you will be traveling from
*
City, State/Province
Please list the city you will be returning to
*
City, State/Province
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Payment Information
The full price for MBM is $6,475 USD. The deposit for MBM is $250 USD, which is refundable up until April 29th, 2024. We must receive your deposit before your application will be considered complete. Once you complete the registration form, you will receive an invoice for the deposit within one week.
Please review and sign the following MBM 2024 Payment Contract:
Please upload a signed copy of the MBM 2024 Payment Contract
*
Browse Files
Cancel
of
If you would like to assist other participants in attending the program by donating to the scholarship fund, please indicate so here by writing how much you would like to contribute. This is considered a tax-deductible donation and we will send you a letter acknowledging your donation.
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T-Shirt Size
Participants will receive a chultzah tnua (youth movement shirt)
Size
*
Small
Medium
Large
Xtra Large
Other Important Info About Your Child
It is essential that you share all important information about your child for us to be the most prepared for this summer. For example, has your child had a hard year in school academically or socially? Has anything important changed at home? Has anything changed in their social group? Please share here or email us at roshmbm@habonimdror.org to set up a call.
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