Youth Department 2020-2021 - Form - Congregation Or Tzion

Youth Programming Registration Form
Please complete one form per participant.

Due to the unprecedented times, we find ourselves in, the Or Tzion Youth Department is offering membership at a 30% discount for the 2020-2021 programming year.

Your membership will include approximately one lounge night and one weekend event per month as well as a youth group t-shirt. Dues will be used to bring in speakers and purchase program supplies. There may be times in which we charge an additional amount for larger online or in-person programs to help cover our costs.

Membership to the Youth Department does not include any USY Regional or International events. Additional information about this coming soon.

In offering a discounted price for the 2020-2021 programming year, we hope to make youth programming more accessible to all families regardless of financial abilities. If you are thinking of becoming an Or Tzion Youth Department member and can afford the dues in full, we ask that you do so, in order to help sustain the Youth Department and its programming. Membership dues should not be a hindrance to participation. For more information, please contact Or Tzion Youth Director Shayna Millman.

Membership Dues will be as follows:

Membership Type	Full Price	2020-2021 Price
Or Tzion Members: USY (7^th -12^th Grade)	$118	$85
Or Tzion Members: Kadima (4^th-6^th Grade)	$100	$70
Non Or Tzion Members: USY (7^th-12^th Grade)	$172	$120
Non Or Tzion Members: Kadima (4^th-6^th Grade)	$154	$108

Enrollment in Or Tzion’s youth groups is contingent upon the signed child and parent’s code of conduct forms. Click Here

Please contact Shayna Millman at at shayna@congregationortzion.org with questions or for assistance.

* Participant's First Name

* Paticipant's Last Name

Paticipant's Cell Number

Paticipant's Email

* Date of Birth

* Age as of 8/2020

* Gender

* Name of Secular School

* Grade as of 8/2020

* T-Shirt Size

Youth Group - full price

Please select one from either sectionOr Tzion Member: Kadima (4th-6th grades)Non-member: Kadima (4th-6th grades)Or Tzion Member: USY (7th-12th grades)Non-member: USY (7th-12th grades)

Youth Group - discounted price

Please select one from either sectionOr Tzion Member: Kadima (4th-6th grade)Non-Member: Kadima (4th-6th grade)Or Tzion Member: USY (7th-12th grade)Non-member: USY (7th-12th grade)

Medical Information

* Physican's Name

* Physician's Phone

* Insurance Carrier

* Policy Number

* Please list all known allergies to Medications

* Please list all prescription medications participant is currently taking.

* Please list all medical conditions of participant

Please list all food allergies. (Gluten Free/Intolerant, Dairy Free, Vegetarian, and others)

Events

I hereby authorize my child to participate in events and programs with Or Tzion's Youth Groups, USY & Kadima. I agree to hold our Congregation (including its board, officers, staff, and volunteers) harmless from any and all claims that may arise out of his/her participation in programs.
Note: Parents will receive advance notice about all programs held throughout the year.

* Events Authorization

We AuthorizeWe DO NOT Authorize

Publicity Release For Minors

We occasionally submit pictures of our activities for publication and/or post them on our website. Please select your permission to publish pictures of your child. I hereby consent to the publication of photographs, quotes, and video of my son/daughter on the Or Tzion website and social media sites for the duration of my child's enrollment. Please note if you are okay with pictures and video and name listing, or okay for pictures and videos with names withheld.

* Publicity Release for Minors

Yes With NameYes Without NameNo

* Parent Signature

* Date

Parent or Guardian Information

* Parent's or Guardian's First Name

* Parent's or Guardian's Last Name

* Parent's or Guardian's Email

Home Phone

* Cell Phone

Work Phone

* Preferred Phone

Occupation

Place of Work

Parent's or Guardian's First Name

Parent's or Guardian's Last Name

* Parent's or Guardian's Email

Home Phone

Cell Phone

Work Phone

* Preferred Phone

Occupation

Place of Work

Emergency Contacts

Please list two emergency contacts. Parents or Guardians will ALWAYS be called first.
Parent or Guardian can be one emergency contact the second must be a non-parent or guardian.

* Emergency Contact

* Relationship

* Best Number

Notes

Emergency Contact

Relationship

Best Number

Notes

Payment Information

Total

Do you wish to make a donation to support our youth programs?

Donations support our youth programs and scholarships to subsidize youth events and regional programs.
Thank you in advance for supporting our youth. Enter your dollar amount above.