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JYCM Individual Membership
If you are a teen in 6-12th grade, you must have a parent or guardian with you when filling out this form.
About You
First Name
Middle Name
Last Name
Your Email
Your Phone Number
Birth Year
School
Anticipated Graduation Year
Mailing Address
City
State
Zip Code
Country
How did you find out about the Jewish Youth Climate Movement?
Parent/Guardian First Name
Parent/Guardian Middle Name
Parent/Guardian Last Name
Parent/Guardian Email
Confirmation Emails concatenated
Are you part of a JYCM kvutzah?
Yes
No
I'm not sure
Kvutzah means "group" in Hebrew. JYCM kvutzot are through schools, institutions, or some other affiliation. If you're not sure whether you're part of a kvutzah we'll follow up to help you figure it out. Any teen in 6-12th grade is invited to join JYCM whether as an individual or through a kvutzah.
Select your Kvutzah
Don't see your Kvutzah? Email us and we'll figure out why you're not showing up on the list.
What is your role in the kvutzah?
Leader
Member
Tier B Program Record ID
Primary Organization ID
A little more about you
These questions are optional.
How can we best meet your access needs? Please use this space to share anything you would like us to know.
What is your gender identity?
Please select...
Man
Woman
Nonbinary
Genderqueer
Prefer to self-describe
Please describe your gender
Pronouns (some common answers include: she/her, he/him, they/them, she/they)
In your own words, how do you identify religiously?
Select the term with which you most identify, even if it is the same as above.
Please select...
Buddhist
Christian
Jewish / Conservative
Jewish / Orthodox
Jewish / Reconstructionist
Jewish / Reform
Jewish / Renewal
Jewish / Secular
Jewish / Traditional Egalitarian
Just Jewish
Muslim
No Religion
Which of the following best describes you?
Please select...
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latinx
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Prefer to self-describe
Please describe how you identify racially
Acknowledgements and Consent
By filling out this form , you will be added to the JYCM newsletter list. Would you like to be added to the general Adamah newsletter list?
Yes
By signing this form, you are committing to represent Adamah and JYCM respectfully and understand that you are joining a national youth movement, dedicated to mitigating climate change by empowering young people, mobilizing our communities, and taking action.
Teen should type name below
You commit to supporting your teens in participating in national JYCM programming and in creating local programming to run at your institutions.
Teen should type name below
For parent or guardian:
I give permission for my child to participate in Adamah's Jewish Youth Climate Movement.
Parent or guardian should type name below
For parent or guardian:
I give permission to Adamah and its programs (including Isabella Freedman, Pearlstone, Adamah Detroit, Jewish Youth Climate Movement, and others), to use any photograph, likeness, audio recording, video recording and/or depiction of my child, and/or my child's name, to promote Adamah and its programs, in all media now known or hereafter developed, including print, electronic and/or digital media, such as brochures, advertisements, annual reports, social media and
Internet websites.
I consent to the publicity release above
I DO NOT consent to the publicity release above
For parent or guardian:
I have read the above terms and have signed it voluntarily and without any inducement or assurance of any nature and intend it to be complete and unconditional. I give my child permission to join the Jewish Youth Climate Movement.
Yes
No
Parent or Legal Guardian signature
Relationship to child
Individual Commitment
In order to continue the development of the program we ask JYCM members to contribute $36 annually. This donation supports both local kvutzah and national programming.
No one will ever be turned away for lack of funds. If you can give more than $36, please do! If you're unable to give $36, please enter another amount that feels like to you like an appropriate and meaningful contribution, between $0-36.
Count me in for $36!
Other amount
Other Amount
Total donation amount
Credit Card Information
Name on Card
Card Number
MM
YY
CVV
Please click the button below only once. If you encounter an error that you cannot resolve, please reach out to us at data@adamah.org.
Contact Information