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FORM - Disclosure Form
All responses are confidential and will only be shared with relevant people.
Name of the young person who was the subject of the disclosure
(Required)
Name of Tzevet member
(Required)
Date
(Required)
MM slash DD slash YYYY
Name of Machane
(Required)
Year Group or Age of young person
(Required)
What was said? Please include as much detail as possible, including times of events/conversations.
(Required)
Who else has been informed?
(Required)
What other action was taken?
(Required)
The Rosh has been informed
(Required)
Yes
No
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Camps
Svivot
Hachshara
Israel Machane
Otzar Torah MiTzion
Aliyah
Contact
Bachad
Donate
Legacy
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