Adamah Climate Week Fellowship Application

Salutation

First Name

Middle Name

Last Name

Email

Your LinkedIn

Mailing Address

City

State

Zip / Postal Code

Country

Which of the following best represents you?

Please specify

Participants under the age of 18 must be accompanied by a legal guardian for the Climate Week Fellowship.

I am 18 or olderI am under 18 and affirm that my legal guardian will also attend

Job Title

Organization/Company/School

By being accepted as an Adamah Climate Week Fellow, you commit to:

Attend the following events:

1:1 meeting with Rabbi Jacob Siegel, Chief National Programs Officer
Fellowship kickoff dinner, Tuesday, 9/22 (midtown, 7pm drinks and 7:30pm dinner)
The Jewish Climate Reception, 9/23 from 12-3pm in partnership with Jewish Climate Trust, at UJA-Federation of New York
Reducing Risk, Building Resilience 9/23 with Adamah NY from 6-8pm, at the Marilyn Meyerson JCC
Virtual debrief gathering (early October, time and date TBD)

Represent Adamah (we’ll supply the Adamah t-shirt) and the Adamah Climate Week Fellowship at at least one other in-person Climate Week event (selected with Adamah support), and share your learning and networking (including sharing with Adamah connections made at the events)

Are you already a member of the Jewish Green Business Network?

Yes

No

I'm not sure

Have you participated in or are you interested in any other Adamah programs (Adamah NY, Adamah on Campus, Adamah Youth Movement, etc.)?

What will you uniquely bring to Adamah's Climate Week Fellowship?

What are the areas where you are most excited to learn and grow?

Anything else we should know about you?

Adamah Photography / Social Media Waiver

There may be photography at these events. We may use photos on our website, in digital promotions, or in print materials. Unless we get your direct consent, we will not use your name along with the photo. If you do not want to be photographed at all, please speak to the lead staff at the event upon your arrival, and take care to not be part of group photos.

I consent to the publicity release above (for myself and all minors for whom I am registering at this time)

Safety and Liability Waiver

I ACKNOWLEDGE that the Participant's choice to participate in the Program is knowing, voluntary, and made for their personal enjoyment. I hereby certify that the Participant is physically fit and capable of participating in this Program and that they do not suffer from any condition, sickness, or disease that would impair their ability to participate in the Program or that presents any danger to their wellbeing as the result of such participation. I assume all the foregoing risks and fully accept personal responsibility for all expenses, medical or otherwise, following any such damages, injury, permanent disability, or death.

I RELEASE and DISCHARGE Adamah and its directors, officers, members, employees, agents, successors, and assigns, from and waive any and all liability to myself, heirs and next of kin or any other person, for any and all claims, demands, losses, or damages, including death or damage to property, which, in whole or in part, arise from, relate to or are alleged to arise from or relate to the Program, any and all related events and activities in which the Participant takes part. I recognize that the Participant has an important personal obligation to conduct themself in a manner compatible with local laws and regulations, and will abide by all such policies and promise to act responsibly and with respect for persons and property.

I agree to terms of the safety and liability waiver (for myself and for all minors for whom I am registering at this time)