Yiddish Farm Application

Yiddish Farm Application
Please apply for Yiddish Farm courses here. If you have questions please email info@yiddishfarm.org

Current Offerings, Dates, and Fees

Semester @ Yiddish Farm

Women's: January 15th through March 10th, 2021

Men's: April 15th to June 10th, 2021

$3500/person, discounts available.

Yiddish Sundays:

Session 1: July 4th, 11th, 18th, 25th

Session 2: August 1st, 8th, 15th, 22nd

$500/person
Name*

First NameLast Name
Jewish Name if Different

First NameLast Name
I am interested in registering for:*

Semester @ Yiddish FarmFour Sundays Session 1Four Sundays Session 2
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Age*
Enter Age
Gender*
Which living arrangement best describes your own needs? Private accommodations will not be available for this year's winter program*

Willing to share a roomOther
How do you intend to pay?*

Check
Please list any allergies
Are you a smoker?*

YesNo
What are your goals for the program?*
Do you know any Yiddish?*
Do you know the Hebrew alphabet?*

YesNo
Some skills that I can contribute to the program are:

Farming, gardening or homesteading skillsI can play an instrumentCarpentry/construction skillsEvent planningAdobe InDesignArtistic/design skillsCooking/baking
Are you Jewish? If yes, please describe your Jewish background. If not, please describe your religious background:*
Do you have a criminal record?*

YesNo
Do you have physical, mental or emotional needs that will require adaptation in housing, program activities, communal living, and/or communication?*

YesNo
If you answered yes to the above, please explain:
Do you have a history of drug or alcohol abuse?*

YesNo
Please list any medications you are currently taking:*
Please list any significant past illnesses, medical or mental health problems:*
How did you hear about this program?*
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Emergency Contact Relation*
Is there anything else you'd like us to know?*
Please Provide 2 Character References*
Please include phone number and relation. (Remember to tell your references that you are listing them here) No family please.
Comments and Questions
Should be Empty: