USY Registration

Temple Emanuel Member**
Kadima: Grades 3-5
Junior USY: 
Senior USY: Grades 9-12
DUES ARE VALID SEP 1, 2019 THRU JUN 30, 2020
**Please note: Temple Emanuel members are billed along with their membership dues.

Online Payment of the Temple Emanuel USY dues is available for people that don’t want their dues included on their synagogue bill or for non Temple Emanuel members. Please use the online payment form after filling out the USY Registration Form.

USY Registration Form: 2019-2020 / 5780

    USY Member Information (Please fill out a separate form for each child)
    First Name
    Last Name
    Street Address
    Home Phone
    Cell Phone
    USY Member Family Information
    Parent1: Name
    Home Phone
    Cell Phone
    Work Phone

    Parent2: Name
    Home Phone
    Cell Phone
    Work Phone
    Did you attend a Jewish summer camp in 2019? YesNo
    Name of camp:
    Did you visit Israel in Summer 2019? YesNo
    Name/type of trip:
    Will you be attending Prozdor in 2019? YesNo
    Are you a Temple Emanuel member? YesNo
    USY Group
    Select your age appropriate group:
    Kadima: Grades 3-5Junior USY: Grades 6-8Senior USY: Grades 9-12
    Medical Information
    Doctor's Name
    Are there any special medical concerns or limitations to your child’s full participation in our youth program?
    Are there any food or drug allergies/special conditions/dietary needs/restrictions on activity/special circumstances of which the Advisors/Director should be aware?
    Parent/Guardian Permission
    I give my permission for my child to participate in the activities of the Youth Department. My child is permitted to use any transportation selected by the advisor and/or Director of Informal Youth Education. I give permission to Temple Emanuel and its agents to secure proper medical treatment in the event of an emergency.
    I give my permission for photos to be taken of my child, and agree that they may be used for Temple Emanuel promotional purposes, including but not limited to our website and social media.
    I would like to receive the weekly Temple Emanuel USY weekly e-newletter. Note that by opting out you will not receive information about upcoming events.
    Please enter Parent's/Guardian's Name
    (in lieu of a signature)
    Membership Agreement
    As a representative of the Temple Emanuel community, I recognize my need to observe appropriate behavior at all times. I agree to be considerate of my peers and the Youth Department staff and I will follow all rules as set at the beginning of each program. While participating in a Temple Emanuel sponsored youth activity, I will follow the Jewish ritual laws regarding Kashrut and Shabbat and I will refrain from the unlawful use of drugs, alcohol and tobacco. I understand that if I don’t abide by these criteria it may result in disqualification from attending future youth events.
    Please enter USY member's name
    (in lieu of a signature)
    Please enter Parent's/Guardian's name
    (in lieu of a signature)