AMUSY-BHUSY-BJUSY Interchapter Shabbaton
Join AMUSY, BHUSY, and BJUSY for an incredible Shabbat together hosted at AMUSY!

Program highlights include:

Musical Shabbat services Friday night
Delicious meals
Programming planned by the incredible chairs!
Icebreakers
Learning
Bus transportation to the CHUSY SA/TO lockin Saturday night (separate minimum donation and registration at www.regpacks.com/chusy1920)
Friends, fun, food and so much more!

Cost for Interchapter is only $85

All 8th-12th grade Jewish teens may attend Interchapter regardless of whether or not they are attending SA/TO Marathon.

Any questions about Interchapter please contact:
Marc Sender YouthDirector@bethjudea.org 847-634-0777 x114
Sandra Kamm smielekamm@amyisrael.org
Sarah Pila bhusyyouth@gmail.com
Email *
Basic Information
USYer First Name *
USYer Last Name *
Grade *
Home Synagogue/USY Chapter *
USYer Cell Phone *
USYer Email *
Parent Name *
Parent Cell *
Parent Email *
Payment Method *
Emergency Information
Emergency Contact Name and Relationship *
This should be different from parent information. We will always try to contact parents first.
Emergency Contact Phone *
Medical/Allergy Information
Please list any specifics the staff should be aware of while your child participates in this program.
Do you need to stay in walking distance of Am Yisrael? *
Please specify any pet allergies that we need to know about for housing purposes *
Release Form
I hereby authorize the staff to seek medical emergency assistance for my child if required. I also hereby fully release and discharge Congregation Beth Judea, Its agents and property owners from any and all claims from injuries,damage or loss which may accrue to my child on account of his/her participation in events sponsored by Am Yisrael, Beth Hillel, and Congregation Beth Judea's Youth Department. I also authorize use of photographs and videos taken during programs to be used by Congregation Beth Judea for various purposes including but not limited to, advertising, sharing around the synagogue, and posted on various social media platforms.

I further agree to indemnify, hold harmless and defend Am Yisrael, Beth Hillel, and Congregation Beth Judea and its agents from any and all claims resulting from injuries, and losses sustained by my child and arising out of,connected with, or in any way associated with the activities of these programs or events.
Today's Date *
xx/xx/xxxx
Parent/Guardian Digital Signature *
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Any Additional Information or Questions?
A copy of your responses will be emailed to the address you provided.
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