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Olim Membership 2019

COS Olim Membership Form 2019-2020
Grades 3, 4, 5 Dues for COS Members: Before 9/30 $75 / After 9/30 $95
Payment for Olim dues - 2019/2020 Programming Year
Olimer Information
First & Last Name
Best for making contact concerning upcoming events
If applicable...or enter a parent/guardian email)
Format: Day/Month/Year
Please send me Olim updates through my social media outlets!

Parent/Guardian Information
Emergency Information
In case of emergency, if parents or 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 Olim events both at the synagogue and on trips for the 2019-2020 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 Conservative Judaism (USCJ).
I understand that I will follow all the rules set by the Ohev Shalom Youth Committee
Wed, August 12 2020 22 Av 5780