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Youth Department Registration

Checks should be made out to Congregation Etz Chaim (Please note Youth Group Membership on the memo line)
or you may pay online using this form
Click on the dropdown arrow to see more options
Child's Information
Parent's Information

Emergency, Safety and Security Information
*For the overall health and safety of your child(ren), please list all medical and/or psychological information we should know about your child(ren) here:
*Your child(ren)’s privacy is very important to us. Great care will be taken to maintain the confidentiality of this information.
The Youth Director will share this information with your child(ren)’s youth group advisor(s), the Synagogue Executive Director, and appropriate medical personnel only as necessary.
If parents cannot be reached, please give the name and
phone number of two people responsible for your child(ren):
Miscellaneous Information

I hereby grant permission for my child, listed above, to participate in Congregation Etz Chaim Youth Programs for the 2019-2020 year. I understand that this permission form grants permission for my child to travel to activities on any mode of transportation selected, including, but not limited to a coach bus, school bus, minivan, van, personal vehicle, taxi or any other form of transportation for any event, including chapter events, sub-regional events or regional events during the 2019-2020 year.

I hereby agree to hold Congregation Etz Chaim, it’s Officers, Directors, agents, servants, employees and
representatives free from any and all liability resulting from any injuries which might occur to my child named
above. In the event of an injury to the child while participating in the program, every reasonable attempt
would be made to notify me. Should I, for whatever reason, not be able to be contacted by reasonable efforts,
I grant permission to those in charge to seek and administer any and all necessary and/or required medical
attention and/or treatment for my child and I further grant permission and authorization to any hospital,
doctor or medical personnel to administer whatever care and treatment they deem necessary for the best
interest of my child, and I expressly agree to assume full financial responsibility for all costs and related
expenses arising as a result and to hold Congregation Etz Chaim and all of its organizations and employees
harmless from any such liability and agree to indemnify them.

I understand that disruptive behavior by my child will not be tolerated and may result in my child being
suspended from upcoming events and/or activities or asked to leave the program. I have discussed these rules
with my child and he/she is aware of the same.

to allow Congregation Etz Chaim and/or its related Departments, to publish for general circulation in any media, Internet, etc., any photographs, video clips, artwork, audio clips, involving any activity in which my child has participated.
All checks will be made out to Congregation Etz Chaim unless otherwise stated on a flyer or application.
The Youth Department prefers checks rather than cash. Due to the amount of pre-planning involved, there will no refunds made for cancellations after deadline date. Please adhere to deadlines. All monies can be turned into the Youth Director via the office at Etz Chaim or at any youth program. No money will be accepted without proper paperwork. If payments are mailed, please address the envelope to the Congregation Etz Chaim Youth Director and make sure to allow enough time for it to arrive.
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Drugs & Alcohol
Drugs and alcohol are not permitted at any Youth function, on or off the Synagogue campus. If it is necessary for the minor child to use prescribed medication while participating in any youth program events, the Congregation Etz Chaim Youth Department must be notified of this, in writing, with specific instructions regarding the administering of such medication. Congregation Etz Chaim assumes absolutely no responsibility with regard to overseeing or supervising the administration of any medications.

All Youth Department participants are to treat each other with respect and dignity. At no time will any derogatory remarks toward one another be tolerated.

Cell Phones
Rarely, we may ask that upon entering a program all cell phones are turned in to the chapter staff. The staff will have his/her phone on and with them at all times, at all programs/conventions, in case of any emergency. That phone number will be available and given to each parent upon request.

Dress Codes
The dress code will vary from program to program. It is mandatory, however, that all those who identify as male, while in the Synagogue, wear kippot. While in the Sanctuary, everyone must have their shoulders covered. Shorts, skirts and skorts must be an appropriate length. Shirts cannot show midriff, back or cleavage and must be free of inappropriate language or insignia. Tank top straps must be two fingers in width.

While participating in any youth program/activity, participants and staff are expected to adhere to the Synagogue policy regarding Kashrut. There may be exceptions to this rule, which will be announced by the chapter staff when applicable. When attending any sub-regional, regional or international events, the International Kashrut Policy will be enforced.

Please be aware that, by signing below, you are indicating that you are aware of the aforementioned policies of the Congregation Etz Chaim Youth Department. If there is a violation of any said policies, our staff has been trained in regards to our standard operating procedure.

All rules and regulations set forth by the HaNegev Region, or
International USY, will be enforced by this department when applicable.
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Tue, April 7 2020 13 Nisan 5780