2026 Nesiah Israel Program Application Form

PART 2 - Parent/Guardian Details
We require consent from both parents of the applicant to participate in the Nesiah Israel program. If there are extenuating circumstances that do not allow for both parents to complete and sign the application form, please advise us in writing explaining the reason to: israel@bje.nsw.edu.au
Are there any court / custody orders in place that may impact this consent ? If you answered yes please forward a copy of the orders to israel@bje.nsw.edu.au
Parent/Guardian 1 Full Name ( Primary point of contact ) *

1 First Name1 Last Name
Is Parent 1 the holder of an Israeli Passport *
Parent/Guardian 1 Relationship to Applicant*
Parent/Guardian 1 Marital Status in relation to parent 2 *
Parent/Guardian 1 Email Address*
example@example.com
Parent/Guardian 1 Phone Number*
Please enter a valid phone number.Format: 0000-000-000.
YesNo
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Full Name*

2 First Name2 Last Name
Is Parent 2 the holder of an Israeli Passport *
Parent/Guardian 2 Relationship to Applicant*
Parent/Guardian 2 Marital Status in relation to parent 1 *
Parent/Guardian 2 Email Address*
example@example.com
Parent/Guardian 2 Phone Number*
Please enter a valid phone number.Format: 0000-000-000.
YesNo
Parent/Guardian 2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PART 4 - Documentation
Please upload a copy of the participant's Australian passport.*

Cancelof
Please upload a photo of the participant's - preferably a recent school photo.*

Cancelof
Please upload a copy of the participant's Israeli passport & army exemption ( if applicable ).

Cancelof
YesNo
YesNo
YesNo

The following pages are consent forms for the Nesiah Israel trip and all associated events. These require parents and in some cases, the students signatures.
Media Consent - for use of images in marketing materials
I, as the parent/guardian of the participant, give permission for BJE and Y2i to use photographs and/or video footage of my child taken during the Nesiah Program for marketing and promotional purposes, including, but not limited to :brochures, flyers, and posters, website and social media channels, newsletters and community reports, promotional materials for future programs. I understand that these materials may be publicly accessible and used to promote BJE and Y2i's educational and cultural initiatives.
YesNo
Parent / Guardian - Media Consent Form Marketing :*

First NameLast Name
Parent/Guardian Signature - Media Consent Form Marketing *

Clear

Media Consent - for use of images in private digital platforms
I, as the parent/guardian of the participant, give permission for BJE to use photographs and/or video footage of my child taken during the Nesiah Program for the purpose of sharing within private, closed digital platforms, including: the official Nesiah private Instagram account, the Nesiah WhatsApp group for participants and families. These platforms are restricted to approved members only and are used to foster community engagement and share program highlights. No images or videos will be shared beyond these channels without additional consent. Representatives of our donors - Y2i, Mosaic United and JCA - may be invited to these channels.
YesNo
Parent / Guardian Name - Media Consent Private Platforms :*

First NameLast Name
Parent/Guardian Signature - Media Consent Private Platforms*

Clear

Code of Conduct
Please read the below Code of Conduct and agree to the terms & conditions set out
Parent / Guardian 1 Name - Code of Conduct *

First NameLast Name
I have read the above Code of Conduct and agree to the terms & conditions set out - Parent / Guardian 1 Signature*

Clear
Parent / Guardian 2 Name - Code of Conduct *

First NameLast Name
I have read the above Code of Conduct and agree to the terms & conditions set out - Parent / Guardian 2 Signature*

Clear
Applicant's Name - Code of Conduct:*

First NameLast Name
I have read the above Code of Conduct and agree to the terms & conditions set out - Applicant Signature*

Clear

Consent, Release and Indemnity Form
Please read the below Consent, Release and Indemnity Form and agree to the terms & conditions set out
Parent / Guardian 1 Name Consent, Release and Indemnity Form:*

First NameLast Name
I have read the above Consent, Release and Indemnity Form and agree to the terms & conditions set out - Parent/Guardian 1 Signature*

Clear
Parent / Guardian 2 Name Consent, Release and Indemnity Form:*

First NameLast Name
I have read the above Consent, Release and Indemnity Form and agree to the terms & conditions set out - Parent/Guardian 2 Signature*

Clear

Payment

Nesiah Israel 2026/27 deposit

Once the deposit is paid, $ 220.00 is NOT refundable. The additional $300 is refundable until Friday, 10 July 2026.

$520.00AUD Quantity

Total

$0.00AUD

Applicant's Details