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Youth Application Form

Youth Department Membership Application 2018 / 2019

USY (Grades 9-12) - $80 Beth Shalom Members - $130 Non Beth Shalom Members

*Kadima (Grades 6-8) - $70 Beth Shalom Members - $100 Non Beth Shalom Members

*Jr. Kadima (Grades 3-5) - $65 Beth Shalom Members - $80 Non Beth Shalom Members

* The price for Kadima & Jr. Kadima membership includes lunches for "in house" programs.  The membership price does not include prices for "out of House" programming.

EMERGENCY INFORMATION

If parent(s) cannot be reached, give name of other person responsible for child who can be called

PARENTAL INFORMATION

PARENTAL CONSENT AND RELEASE

I hereby grant permission to Congregation Beth Shalom and its agents to call a physician for necessary medical care or hospitalization for my child/children in case of an emergency, after attempting to notify me first.  I further permit  my child to attend all functions arranged by Congregation Beth Shalom and do hereby release Congregation Beth Shalom, its officers, agents, and employees from any and all libility arising from my child/children's participation in such activities.

POLICIES AND PROCEDURES

Click here to read the policies and procedures for being a member of the Youth Department. Please print page  and have both child and parent sign and date.  Send to the Beth Shalom Office or you can scan and email to Ryan@bethshalom.net

Sat, November 16 2019 18 Cheshvan 5780