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USY Gesher Membership 2021

USY Gesher Membership Form 2021-2022
Grades 6-8 Dues for COS Members: $50
Grades 6-8 Dues for COS Non-Members: $100
Please choose either the member or non-member rate
USY Gesher Information
First & Last Name
Cell Number or Most Used
Format: Day/Month/Year

Parent  / Guardian Information
Emergency Information
In case of emergency, if parents / guardians cannot be reached, please provide another contact name.
to be contacted in case of an emergency
If parents, guardians, emergency contacts, or physician cannot be contacted, I give consent for COS youth staff to utilize services and closest hospital emergency room.
I give permission for my child to participate in all Kadima events both at the synagogue and on trips for the 2021-2022 program year and release Congregation Ohev Shalom and its representatives from any liability. I acknowledge that my child must follow all the rules set forth by the Congregation Ohev Shalom Youth Commission in coordination with the guidelines specified by United Synagogue Youth (USY) and United Synagogue Conservative Judaism (USCJ).
I understand that I will follow all the rules set by USY Gesher, the Ohev Shalom Youth Committee, and Congregation Ohev Shalom.
Wed, October 20 2021 14 Cheshvan 5782