Elders Shabbaton Registration Form

Salutation

First Name

Middle Name

Last Name

Email Address

Birth Year

Zip Code

Optional Demographic Questions

We strive to make our programs as diverse, equitable, and inclusive as possible. Knowing more about you helps us do that. We acknowledge that identity is complex and that your identity may not fit into these categories. The following questions are optional, but strongly encouraged.

How do you identify religiously?

Please describe how you identify religiously

What is your Jewish ethnicity?

Please describe your Jewish ethnicity

What is your gender identity?

Please describe your gender

Which of the following best describes you?

Please describe how you identify racially

Program Questions

What draws you to attend this Shabbaton?

How are you engaged with Judaism in your life?

Where do you see yourself on your "eldering" journey?

Anything you would like to share about yourself?

Any questions or concerns?

We are looking for people to be part of the musical prayer team for the Jewish renewal style sat morning service (for a reduced fee ticket). Would you be interested in this?

YesNo

Please tell us more about what instruments you play and your experience with this.

Communications

By registering, you consent to receive program-related emails. Would you like to be added to the Adamah SF newsletter list?

Yes

Would you like to be added to the general Adamah newsletter list?

Yes

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

Adamah Photography / Social Media Waiver

There may be photography at this event. 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

Pricing

Program Fee: Sliding Scale: $225–$295

Sliding scale selection

Discount Amount

We are able to offer this equitable registration system due to the generosity of our donors and participants. If you are able, we welcome donations of any size to subsidize this program.

Optional donation

Payment Amount For SF Mapping

Total Amount

Discount Amount For SF Mapping

Credit Card Information

Card Number

MM

YY

CVV

Billing Street Address

City

State

Zip Code

Country

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.