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USY Membership Form 2022-23

The Conservative Movement requires that members of USY 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, our Rabbi would be happy to discuss your individual situation
Scholarship money is always available. If dues are a financial concern, please email
*If you belong to another synagogue which has a USY chapter, you may not join Neve Shalom’s chapter without permission from your synagogue. Please contact Neve Shalom’s Youth Chair at for more information
I do hereby consent and agree to the participation of my child in all activities of the Neve Shalom USY Youth Program. I (the parent or legal guardian) of the applicant state that they are in good/normal health, have no physical or mental handicaps that would interfere with full participation in the program and has my permission to engage in all available activities except as noted under restrictions or modifications below. I have been made aware of the fact the events in which my child is participating may be photographed, that the photographs taken may be used both for purposes of reporting on the event or for such other use as Neve Shalom USY may determine.

 In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parent(s) or guardian of the child. In the event they cannot be reached, I hereby give permission to a physician selected by the youth program, its employees, advisors or agents, to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia, or surgery for my child as named above. I am aware that this form may be photocopied for use by medical caregivers. 

This registration form serves as my electronic signature understanding and agreeing to the above emergency policy.
Sun, December 3 2023 20 Kislev 5784