Beth El USY Registration

Personal Information

Name:
Sex:
Male Female
Address:
 
Street Address
City / State / Zip
E-mail:
Phone:
Birthday:
Grade:
Vegetarian:
Yes No
If yes, do you eat:
Chicken Turkey Fish
Hebrew Name:
T-Shirt Size:
S M L XL XXL

Parent Information

Father / Guardian:
Mother / Guardian:
Hebrew Name:
Hebrew Name:
Work Phone:
Work Phone:
Parent E-mail:

Emergency / Medical Information

Emergency Contact:
Phone:
Insurance Company:
Policy Number:
Physician:
Phone:
Current Medication:
Check if being sent
Allergies:

My child has my permission to participate in all Beth El Synagogue Youth activities. I also give permission for my child to ride a bus to any events, as needed. In case of emergency, I give the adult in charge my permission for medical treatment to facilitate immediate emergency action. I hereby authorize the medical personnel to order x-rays, routine tests and treatment for my child, and in the event I cannot be reached in an emergency, I hereby authorize the physician to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child as named within. I understand that I shall be responsible to pay for any medical care rendered to my child while participating in any Beth El Synagogue function.

Beth El Synagogue Code of Conduct for Beth El Synagogue Youth Events

For purposes of this Code of Conduct, a "BETH EL SYNAGOGUE event" or "activity" shall include all times from when a BETH EL Youth leaves his or her home, through when the USYer returns to his or her home, including free time and during transportation to and from the event, and all times during home-hospitality Beth El Synagogue events.

  1. Kashrut will be observed, including during transportation to and from BETH EL SYNAGOGUE events, and during "free time."
  2. Religious Observance. All BETH EL YOUTH and staff shall observe the religious policies established by the United Synagogue of Conservative Judaism, including those pertaining to Shabbat observance (including arrival prior to Shabbat and travel on Shabbat exclusively to a scheduled synagogue event or services); all males must wear Kippot during all services and meals, and Tallit/Tefillin for morning services, where appropriate. All BETH EL YOUTH shall wear clothing appropriate to the event/location.
  3. Possession or use of any weapons, alcohol, tobacco products and/or illegal drugs is not permitted at a BETH EL SYNAGOGUE event. Gambling for anything other than charitable purposes in connection with a sanctioned BETH EL SYNAGOGUE program is not permitted.
  4. Timely attendance at all scheduled BETH EL SYNAGOGUE event activities is required, and only those registered for the BETH EL SYNAGOGUE event are permitted to attend, unless otherwise approved by Beth El staff. No BETH EL YOUTH may leave the premises in which a scheduled event is located without prior approval of Beth El staff, as well as prior permission of the parent/guardian. No BETH EL YOUTH shall be permitted to drive unsupervised to an out-of-town regional event.
  5. Home Hospitality. All housing assignments for home hospitality are final, and any changes may only be made with the express permission of Beth El staff. Prior to scheduled events, BETH EL YOUTH and staff must proceed directly to the place for scheduled event. Following scheduled events, BETH EL YOUTH and staff must proceed directly to the assigned home.
  6. Camp/Hotel Hospitality. Males are not permitted in sleeping rooms occupied by females, and females are not permitted in sleeping rooms occupied by males. No BETH EL YOUTH shall leave his/her room after curfew.
  7. Observance of Civil/Criminal law. No BETH EL YOUTH or staff shall violate any civil or criminal law, including, but not limited to, those related to tampering of or destruction to property, and destruction of one's own or another person's physical and/or mental integrity. Inappropriate or unwelcome physical contact or language, indecent attire or public nudity, shall not be permitted.
  8. Cooperation with Staff. Each BETH EL YOUTH shall fully cooperate with every staff person, including volunteer staff persons, and shall otherwise adhere to all rules established for the event.

Anyone who violates this Code of Conduct shall be subject to disciplinary consequences, including, but not limited to, being sent home at the expense of the violating BETH EL YOUTH or staff member (or his/her parent/guardian), monetary payment for personal and/or property damages and suspension from future BETH EL SYNAGOGUE events. Beth El staff reserves the right to enforce these and any other behavioral rules, and impose additional sanctions with respect to behavior that would otherwise affect the integrity of the BETH EL SYNAGOGUE event and/or the health, safety and welfare of its participants and staff.

By submitting this form, you indicate that you have read the Beth El Synagogue Code of Conduct and agree to abide by its terms.