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.
Is Parent 1 address the same as the applicant

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.
Is parent 2 address the same as the applicant

YesNo
Parent/Guardian 2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PART 3 - Poland Option - Expressions of Interest
Expression of interest

Students can elect to participate in the Poland Option, this is at an additional cost for parents (costs to be advised ).

Applicants wishing to participate in this will leave a few days before the main group.

The Poland program is a detailed investigation into Jewish history, focusing on the Holocaust. Participants are required to participate in a BJE Holocaust Education Course.

Please note: this option is NOT available to family’s accessing means tested financial assistance.
The applicant is interested in the Poland option*

YesNo

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
I agree to take out the required travel insurance as requested by BJE in order to participate on the Nesiah Israel program.*

YesNo
I understand ALL applicants are required to complete the Y2i form irrelevant of whether you are accessing either the (up to)$5000 Y2i Subsidy or the means tested Financial Assistance LINK: https://y2i.typeform.com/subs2026*

YesNo
I would like to utilise the Mosaic United voucher ($1,500-$2,000 approx ) and agree for my child's details ( name, email address ) being shared with Mosaic United.*

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.
I have read the above Media Consent Form - Marketing and agree to the terms & conditions set out*

YesNo
Parent / Guardian - Media Consent Form Marketing :*

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

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.
I have read the above Media Consent Form - Private Platforms and agree to the terms & conditions set out*

YesNo
Parent / Guardian Name - Media Consent Private Platforms :*

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

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*
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*
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*

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*
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*

The Application for Nesiah is not complete and an’ Offer of place’ on the program cannot be made by BJE until all the following conditions are met:
- The Nesiah application form is completed and submitted
- The application form is completed and signed by BOTH parents or you have emailed israel@bje.nsw.edu.au
- You have attached a copy of a valid Australian passport with at least 6 months validity, and a copy of the applicants Israeli passports and army exemption ( if applicable )
- The deposit is paid on application
- You have sent the link to your child's school for the school reference to be completed https://form.jotform.com/250610655331044
- You have completed the Y2i application form regardless https://y2i.typeform.com/subs2026
I confirm that I am applying for my child to participate in the Nesiah program and that all information provided on this application form is correct. I have read the above requirements for applying to the Nesiah program and understand that if I do not meet these requirements, my child may not be offered a place in the program.

Yes
Parent / Guardian 1 Name :*

First NameLast Name
Parent/Guardian 1 Signature - Nesiah Israel Program Application*
Parent / Guardian 2 *

First NameLast Name
Parent/Guardian 2 Signature - Nesiah Israel ProgramApplication*

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

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

2026 Nesiah Israel Program Application Form

Applicant's Details

Medical Information

PART 2 - Parent/Guardian Details

PART 3 - Poland Option - Expressions of Interest

PART 4 - Documentation

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

Media Consent - for use of images in private digital platforms

Code of Conduct

Consent, Release and Indemnity Form