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USY Registration 2017-2018

Please complete the form below to register your child for Youth Group at Congregation Shaarei Kodesh.

Please fill in medical and insurance information completely.

Photo Release

I grant Congregation Shaarei Kodesh the right to take photographs of my child. I authorize Congregation Shaarei Kodesh to use and publish the same in print and/or electronically.

I agree that Congregation Shaarei Kodesh may use such photographs of my child with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above:


I hereby give permission for my child to participate in the 2017-2018 Youth Department program at Congregation Shaarei Kodesh, on both Regional and Sub-Regional Levels. In the event of an emergency, surgical or otherwise, and I cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility and specifically authorize the representative of Congregation Shaarei Kodesh to select a physician and/or authorize medical treatment, including hospitalization, anesthesia, injection or other measures which he/she feels are in the best interest of my son/daughter.

Further, I give my permission to allow my son/daughter to travel by bus or car to chapter/ sub regional and regional events as well as be photographed and used in pictures to promote Youth department activities.


 **I understand that this waiver that I sign will be the predominant permission slip for the year for my child unless another slip is required**


USY (9th-12th Grade)

Congregation Shaarei Kodesh members                  $135

Non-members of Congregation Shaarei Kodesh       $180


Dues include:

Chapter t-shirt, office overhead, photocopying, postage, mailings, flyers, office supplies, membership to the United Synagogue Youth Group (regionally and internationally), and programs held at Congregation Shaarei Kodesh.


Not included:

Programming and transportation costs throughout the year for programs that are not held at Congregation Shaarei Kodesh.

Thu, March 22 2018 6 Nisan 5778