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USY Membership 2018

COSUSY Membership Form 2018-2019
Grades 9-12 Dues for COS Members: Before 9/29 $85 / After 9/29 $100
Grades 9-12 Dues for COS Non-Members: Before 9/29 $385 / After 9/29 $400
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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 2018-2019 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 and Congregation Ohev Shalom.
Sun, December 15 2019 17 Kislev 5780