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USY Membership 2019

COSUSY Membership Form 2019-2020
Grades 9-12 Dues for COS Members: Before 9/29 $90 / After 9/29 $105
Grades 9-12 Dues for COS Non-Members: Before 9/29 $385 / After 9/29 $400
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Please choose either the member or non-member rate
USYer Information
First & Last Name
Cell Number or Most Used
Format: Day/Month/Year
Please send me USY updates through my social media outlets!

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 USY 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 Youth (USY) and United Synagogue Conservative Judaism (USCJ).
I understand that I will follow all the rules set by USY, the Ohev Shalom Youth Committee, and Congregation Ohev Shalom.
Thu, December 12 2019 14 Kislev 5780