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USY Membership Form 2019
First Name:
Last Name:
Address:
City:
Zip Code:
Home Phone:
USYer's Email Address:
Grade:
9th Grade
10th Grade
11th Grade
12th Grade
Birthday:
Parent #1 - Name:
Parent #1 - Email:
Parent #1 - Mobile:
Parent #2 - Name:
Parent #2 - Email:
Parent #2 - Mobile
Please list all allergies:
Please note that many of our events include food. If your child has an allergy:
My Child's allergies require an epi pen. We keep one at Neve Shalom.
My Child's allergies require an epi pen. He/she will self carry at all chapter functions.
Is the USYer born of a Jewish mother or converted to Judaism?
Yes
No
The Conservative Movement requires that members of Kadima be Jewish according to the traditional ritual definition of Jewish identity, either being born of a Jewish mother or having gone through a process of conversion or ritual affirmation of membership in the Jewish People. Should you wish, Rabbi Rosin would be happy to discuss your individual situation
Dues: Please download the
permission slip/emergency form
and return the completed form along with check made payable to Metuchen USY to the office at Neve Shalom.
)
Neve Shalom Member:
Grade:
Neve Shalom Member: 9th ($60.00)
Neve Shalom Member: 10th ($60.00)
Neve Shalom Member: 11th ($60.00)
Neve Shalom Member: 12th ($60.00)
Neve Shalom Associate Member ($80)
Non-Member: ($80)
*If you belong to another synagogue which has a Kadima chapter, you may not join Neve Shalom’s chapter without permission from your synagogue. Please contact Neve Shalom’s Youth Chair at youth@neveshalom.net for more information
Do you belong to a synagogue?
Yes
No
If so, which synagogue do you belong to?
Total amount due:
Sun, February 23 2020
28 Shevat 5780
Sun, February 23 2020 28 Shevat 5780
