SchZFTY Winter Shul-In Registration

Student's Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Student's Cell*

Student's Email*

What Temple Youth Group (TYG) does this student belong to?*

Parent/Guardian Contact Information

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Email*

This parent/guardian will receive an automatically-generated email confirming enrollment after this form is submitted.

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Work Phone

Would you like to add a second parent/guardian?*

Yes
No

Parent/Guardian #2 Contact Information

Parent/Guardian 2 Name*

First Last

Parent/Guardian 2 Email*

Parent/Guardian 2 Cell Phone*

Parent/Guardian 2 Work Phone

Name of Parent with whom child lives*

First Last

Emergency Contact Information

Please let us know who we should contact in case we are unable to reach either parent.

Name*

(Emergency contact should be someone other than a parent or guardian.)

First Last

Phone*

Release Forms

Consent*

I hereby give permission for my child to attend Congregation Schaarai Zedek Youth Group events. He/she is in good physical health and does not have any physical limitations (If there are any physical limitations, special dietary needs, allergies, etc., please indicate below)

I agree.

Insurance Company

Insurance Company Phone

Insurance Policy Number

Physician's Name

Physician's Phone

Dentist's Name

Dentist's Phone

Please list any medications your child regularly takes:

Please list any allergies:

Please list any dietary restrictions:

Medical*

I empower the advisors of Congregation Schaarai Zedek or their agents to act for me in accordance with their best judgment in an emergency. I hereby give permission to the physician selected by their advisor to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.

I agree.

Code of Conduct*

1. The drinking and/or possession of intoxicating beverages, even if the participant is of drinking age, is strictly prohibited (other than sacramental wine at the appropriate ritual times.)

2. The possession and/or use of any illegal drug, including marijuana, and/or the supplying of drugs to any person at any function is strictly prohibited.

3. No gambling is permitted except for fund-raisers approved by Congregation Schaarai Zedek.

4. No smoking is permitted at any event.

5. Vandalism, disturbing the peace, or other inappropriate behavior will not be tolerated. Any damage to the Temple, personal, or public property must be paid by the person(s) who caused the damage.

6. Curfews and/or check-in times are to be observed when applicable.

7. Any act by a member that is in violation of Federal, State, or Local law will be in violation of this Code of Conduct.

8. There are no guests allowed at events without the advance permission of Congregation Schaarai Zedek. Unauthorized guests will be asked to leave immediately. A guest is defined as anyone who is not the child of a Temple member and/or anyone not registered at a temple-sponsored event.

9. Once a member arrives at an event, they may not leave and return to that event without permission from the advisor of that event or from the member's parents. If a member chooses to leave early without advisor or parental permission, they will not be allowed to return to that event. In either case, the advisor must be notified in advance.

10. TRIPS: Rules for appropriate community standards will be enforced on all trips.

10 A. Teens are to be in their assigned rooms only. Realizing that it is fun for teens to watch T.V. and movies and to socialize, they may do so together only in rooms designated for that purpose, as long as an advisor is present.

10 B. Mixed sleeping arrangements in a common area (such as a congregational social hall) are permitted as long as adult advisors (over 21) are present at all times. However, each attendee should have his/her own sleeping bedding. Sharing of sleeping bags and/or other sleeping bedding is not appropriate when sleeping in an open common area.

10 C. Teens can get together in common areas as designated by the advisor.

10 D. Appropriate curfews will be determined by the advisor.

11. Any additional rules pertinent to the specific event shall be announced by the leadership and/or the Youth Director and shall be observed as written rules.

ANY INFRACTION OF THE ABOVE RULES WILL RESULT IN DISCIPLINARY ACTION BY THE YOUTH DIRECTOR. ANYONE EXPELLED FROM A SCHZFTY EVENT IS NOT ENTITLED TO ANY FINANCIAL REIMBURSEMENT AND THAT PERSON MAY BE RETURNED HOME AT THE EXPENSE OF THE PARENTS.

We have read the above rules, understand, and will abide by them.

Youth Group Activities Release*

Separate and apart from the undersigned’s intent to release Congregation Schaarai Zedek, Inc, the Board of Trustees, SchZFTY, its agents, members, and employees from all liability arising from transportation, and in consideration for my/our child being allowed to take part in SchZFTY, NFTY-STR, NFTY or Congregation Schaarai Zedek sponsored activities, I/We for my/our child, our heirs, executors and administrators, legal representatives and assigns, release and forever discharge Congregation Schaarai Zedek, Inc, SchZFTY, their agents, employees, members, representatives, successors and assigns of all liabilities, claims, actions, damages, costs or expenses which I/we may have against them, including all negligence-based claims, actions, damages, costs or expenses which my/our child may have against them arising from or in any way connected to my/our child’s participation in SchZFTY, NFTY-STR, NFTY or Congregation Schaarai Zedek sponsored event or activities. This release/covenant not to sue constitutes a waiver of claims arising from injuries that may be suffered before, during, or after the SchZFTY, NFTY-STR, NFTY or Congregation Schaarai Zedek sponsored event, as a result of alleged negligence on the part of SchZFTY, the Board of Trustees, agents, employees, members, representatives, successors and assigns. I/We understand that this waiver includes any claims based on negligence, inaction, action, or any of the above-referenced individuals and/or entities.

I agree.

COVID Protocols I*

Individuals who have any of the following symptoms will not be allowed to participate in the SchZFTY Winter Shul-In: fever, coughing, sneezing, shortness of breath, difficulty breathing, sore throat, loss of smell or taste, chills, muscle pain, headache, runny nose, rash, abdominal pain, diarrhea, vomiting, and/or lethargy. By signing below, I attest/confirm that my child has been fully vaccinated for COVID-19. I understand that if my child becomes sick a rapid COVID test will be administered and if there is a positive result my child MUST be picked up immediately at my own expense.

I agree.

COVID Protocols II*

This event is hosted by Congregation Schaarai Zedek. By attending, I agree my child will follow the COVID requirements and guidelines of Congregation Schaarai Zedek. I understand that requirements and guidelines may change as determined by Congregation Schaarai Zedek up to and including the duration of the SchZFTY Winter Shul-In. I understand and agree that if my child fails to comply with the requirements and guidelines they will be sent home at my own expense.

I agree.

Signature*

By typing my name, I confirm I have read, understand and agree to the above.

Date*

Payment

Upon submission, you will be taken to PayPal's website, where you can enter your credit card information and complete your submission. Your submission is not complete until you enter your credit card information and process your payment.

Registration Fee

Price:

Total Due Today

$0.00