BZBI USY Registration 2017-2018
USY (United Synagogue Youth) is a BZBI's youth group for students in grades 8-12. The group offers BZBI teens an autonomous space to explore their Judaism in a meaningful way in a modern urban setting.
Please enter your email address in order to begin completing the form.
Email address *
Teen's Information
To be completed by the teen participating in the program
Teen’s Name *
Your answer
Teen’s Email *
Your answer
Teen’s Cell Phone *
Your answer
Teen’s Birthday *
MM
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DD
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Grade as of September 2017 *
School *
Your answer
Home Address (Street, City, State, Zip) *
Your answer
Home Phone Number *
Your answer
I would like to be involved in planning one or more of the USY events. *
Parents' Information
To be completed by the parent(s)
Parent 1 Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Cell *
Your answer
Parent 2 Name
Your answer
Parent 2 Email
Your answer
Parent 2 Cell
Your answer
Home Phone Number *
Your answer
Home Address (Street, City, State, Zip) *
Your answer
Additional Address (Street, City, State, Zip)
If applicable
Your answer
I/We would be willing to chaperon USY events. *
I would be willing to provide transportation to USY events. *
Photography Permission *
Emergency Information
Emergency Contact Name *
Other than parents
Your answer
Emergency Contact Phone *
Your answer
Does the student have any allergies? *
If yes, please list the allergies
Your answer
Parent’s and Youth Group Member’s Pledges
Please type in your name as an electronic signature
Parents' Pledge *
I give permission for my child to participate in USY activities as planned by the youth group's advisor of Temple Beth Zion-Beth Israel. In case of medical emergency, I give permission to the physician selected by the Youth Advisor to hospitalize and to secure proper treatment for such an emergency. I understand that every attempt will be made to contact me first. I understand that if my child cancels after making a program reservation that we are still responsible to pay for any expenses incurred because of that reservation.
Your answer
Parents' Pledge Date *
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DD
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YYYY
Youth Member's Pledge *
I understand that I will be participating in a Jewish youth program that is connected with Temple Beth Zion-Beth Israel. I agree to abide by the rules of BZBI USY and United Synagogue Youth at all events and trips. I will also observe the rules of Kashrut when I am at these events. I understand that some events are held at BZBI, some at other synagogues and at outside places. I will respect these places and their rules. If I am found not to follow the rules and/or not listen to the chaperones, I understand that my parents will be contacted and I may not be able to attend future events.
Your answer
Youth Member's Pledge Date *
MM
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DD
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YYYY
Payment Information
USY Membership dues are $50 per teen.
If you are paying by check, please make checks payable to BZBI and note that the check is for USY dues.
If you are paying by credit card, please use the PayPal link below.
What is your preferred form of payment? *
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