Youth Group Enrollment

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*

Youth Group Selection*

Jr. SchZFTY - Grades 6-8 (Temple Member)
Jr. SchZFTY - Grades 6-8 (Non-Member)
SchZFTY - Grades 9-12 (Temple Member)
SchZFTY - Grades 9-12 (Non-Member)

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.

Transportation*

I/ give my/our child, permission to be transported by bus, car, or other means of transportation approved by the Congregation from the time he/she arrives at any SchZFTY, NFTY-STR, or NFTY event until he/she leaves that event.

(I) further understand that if, for any reason, (my) child is utilizing transportation outside of the SchZFTY provided transportation for any given event, (my) (our) parental permission will have to be given in writing and approved by the Congregation prior to the start of the event.

I agree.

Covenant Not to Sue*

In consideration for transporting my/our child for any SchZFTY, NFTY-STR, NFTY or Congregation Schaarai Zedek sponsored event, I/We, individually and on behalf of my/our child, hereby knowingly and freely waive any and all causes of action including any and all claims or causes of action arising from or related to any negligence on the part of the agents, employees, members, representatives, successors and assigns of Congregation Schaarai Zedek, Inc, its Board of Trustees, and SchZFTY, as well as any negligence-based claims of liability arising from such transportation as referenced in this Release, which my/our child and I/we may have or acquire against SchZFTY, Congregation Schaarai Zedek, Inc. its Board of Trustees, their agents, employees, members, representatives, successors and assigns.

I/We hereby agree that I/We, individually and on behalf of my/our child, will hold SchZFTY, Congregation Schaarai Zedek, Inc. its Board of Trustees, any their agents, employees, members, representatives, successors and assigns harmless for any and all claims for damages arising or which may arise from such transportation, including any alleged negligence on the part of SchZFTY their agents, employees, members, representatives, successors and assigns. Additionally, the undersigned agrees to indemnify and hold harmless SchZFTY, including members of Congregation Schaarai Zedek, Inc., its Board of Trustees, their agents, employees, members, representatives, successors, and assigns for any costs, attorney’s fees, or any other monies which are expended as a result of any claims or lawsuits arising from or relating to transportation, as referenced in this Release.

I agree.

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.

Signature*

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

Date*

Payment

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Youth Group Enrollment

2021-2022 Youth Group Enrollment

Parent/Guardian Contact Information

Parent/Guardian #2 Contact Information

Emergency Contact Information

Release Forms

Payment

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