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Arvot USY Fall Sub-Regional Convention
“NoBODY’s perfect: Appreciating the Uniqueness of Others”
Cost: $ 130 - Payable to Beth Ahm Israel Youth Department
(Applications are due Sept 22nd after 9/22 cost $145 and spaces not guaranteed)
Please print clearly:
Name ______________ Chapter __________ __Grade_ Gender ________
Address_________________________________________________ _____________________________________
City _______________________________________________ State _______________ Zip _________________
E-mail ________________________________________USYer’s Cell Phone _______________________________
Home Phone Number_____________________________
Parent’s Name _______________________________ Parent’s Home Phone (if different) _______________________
Parent’s Work Phone (mother)______________________________ (father)_____________________________
List 3 USY’ers who you would like to room with, in order of preference:
1. Name Chapter ________________________
2. Name Chapter ________________________
3. Name___________________________________ __Chapter________________________
Every effort will be made to honor your mutual requests. Requests will only be considered if forms are received on time. In addition, please understand that no rooming changes will be made before or during any part of the convention.
Circle one:
Yes No Vegetarian - If yes, will you eat chicken, eggs or fish? (Circle those that apply.)
Yes No Any allergies or restrictions? If yes, please specify _______________________
Yes No Do you require walking distance?
Yes No Do you require a kosher home?
I am interested in leading: (check all that apply)
__ Kiddush __ Maariv Shabbat __ Weekday Shacharit __ Kabbalat Shabbat
__ Birkat HaMazon __ Torah Reading __ Weekday Mincha __ Haftorah
__ Hamotzi __ Shabbat Mincha
We have read the attached rules and the applicant agrees to abide by the rules of convention. We understand that any infraction of the rules could result in the applicant being sent home from the convention at the applicant’s expense.
Signature of Applicant _____________________________________ Date ____________________________
Signature of Parent ________________________________________ Date ____________________________
Signature of Youth Director_______________________________ Date____________________________
APPLICATIONS ARE DUE
No Later than _______________ to your chapter YD
CONSENT, AUTHORIZATION, AND RELEASE
Date of Birth: ________________________
THIS CONSENT, AUTHORIZATION, AND RELEASE (“Consent”) is provided to UNITED SYNAGOGUE YOUTH, SE REGION, a department of the United Synagogue of Conservative Judaism, with regional headquarters in Boca Raton FL (“USY”) is connection with USY Arvot Sub-regional Convention, to be held at Beth Ahm Israel, October 10-12, 2008 (“Scheduled Activity”).
1. The minor has my consent to attend and to participate in the Scheduled Activity. There are no limitations or restriction of any kind whatsoever on such participation unless this box, _____ is checked with explanation attached to this form.
2. The Minor has been instructed by me, and understands and agrees, to comply with all rules, regulation, and Codes of Conduct established by USY and the official instructions and directives of all authorized staff members, volunteers, agents, and employees (“Personnel”) of USY.
3. You are expressly authorized to administer, prescribe and/or direct the administration of any medication, other medical treatment, care, surgery, hospitalization or medical procedures and services deemed appropriate under the circumstances, if you are not able to timely contact me for instructions, acting as my authorized agent and at my sole cost and expense. There are no exceptions or limitations, or other special instructions, in connection with the foregoing, unless this box _____ is checked, with explanation attached to this form.
4. Unless this box _____ is checked and I have provided you with specific instructions, directions or other specific data to the contrary, on an attached page, you assume that the Minor has no medial disabilities, allergies or other limitations or any kind whatsoever that might in any way limit participation in the Scheduled Activity.
5. I expressly release and agree to indemnify and hold USY (and its Personnel) free and harmless from any and all liability, charges, claims, costs, and expenses of every kind and nature whatsoever, including reasonable attorney fees, in connection with the acceptance and participation of the Minor in the Scheduled Activity. The foregoing Release is without reservation of any kind except only for such acts or omissions on your part that arise out of your intentional or negligent wrongdoing and without fault of any kind on the part of the Minor or on my part in failing to disclose pertinent information to you.
6. I represent to you that I have the sole, full and legal power and right to execute this Consent, and that you will rely on my representations.
7. If this consent is signed by more than one person, all references to the singular shall include the plural, jointly and severally.
I DECLARE UNDER THE PENALTY OF PERJURY THAT I HAVE READ AND FULLY UNDERSTAND THE IMPORTANCE AND THE EFFECT OF THE FOREGOING CONSENT, AUTHORIZATION, AND RELEASE: THAT I HAVE OBTAINED SUCH ADVICE OF AN ATTORNEY AND OF A LICENSED PHYSICIAN AS I DEEMED NECESSARY, TO MY COMPLETE SATISFACTION; AND THAT I SIGNED THIS CONSENT ON ___________________, 20___.
Signed ____________________________________________ *_____________________________
Signed ____________________________________________ *_____________________________
*Relationship to Minor
Insurance Company Name ___________________________________ Policy Number ________________
Address ____________________________________________________ Phone___________________
Chapter Registration Form
The following USY’rs fulfill all of the standards and regulations set forth by the Southeast Region Youth Commission. These USY’ers are members in good standing and have paid their dues for the 2008-2009 year.
Event: Arvot Fall Sub Regional Convention
Chapter: _________________________#Applications: ____ Youth Director/Advisor attending: __________________ Phone Number: ____________________
PLEASE LIST NAMES OF ALL ATTENDEES: ATTACH ALL APPLICATIONS.
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The following signatures are required for these USY’ers to attend this event. Please sign and return to Beth Ahm Israel by September 22,2008.
__________________________________________ _________________________________
Youth Commission Chairman’s Signature Rabbi’s Signature
__________________________________________
Youth Director/Advisor’s Signature
Mail this form along with applications to: Amanda Charson , Beth Ahm Israel Youth Department
9730 Stirling Road Cooper City . FL 33024
In Connection with the HaNegev Region or any of the affiliated sub regions (Arvot, Mercaz, Ein Gedi):
1. There is to be no smoking.
2. There is to be no possession or use of any narcotics, marijuana, other illegal drugs, or prescription drugs not prescribed for the user.
3. There will be no consumption of any alcoholic beverages.
4. There will be no shoplifting or theft of any kind.
5. If a USYer is caught in possession of/or using alcohol or illegal drugs or is caught shoplifting and/or involved in theft of any kind, he/she will immediately be sent home at his/her parents’ expense. Furthermore USY International policy states, "if a USYer is apprehended for an infraction of the national youth commission's policy regarding drug and alcohol abuse or any other criminal offense (including, but not limited to, shoplifting) punishment for that offense will include suspension from international USY events (including, but not limited to, the International USY convention and USY summer programs) for one year following the infraction.” The USYer’s region reserves the right to impose additional sanctions in connection with this or any other improper behavior as it sees fit.
6. Each participant is expected to maintain proper decorum and attitude during the entire program. Disruptive behavior (including, but not limited to, inappropriate sexual behavior) will not be tolerated. Your parents will be responsible to pay for any damage you may cause.
7. No participant may leave the program without the express permission of the director of USY.
8. Each participant is expected to conduct him/herself appropriately as a Conservative Jew (including observance of Shabbat and Kashrut), in accordance with the applicable standards of the Committee on Jewish Laws and Standards of the Conservative Movement and/or the local rabbinic authority.
9. The Region reserves the right to search the room and belongings of any attendee if it has reasonable grounds to believe that such a search is necessary to secure the health, safety and/or welfare of the program and or its participants. The USY Director, in consultation with the regional youth commission, reserves the right to enforce other rules relating to the integrity of the program and/or the safety, health or welfare of its participants.
By my signature, I certify that I will adhere to the program, observe the convention code (which I have read), and will conduct myself in a manner reflecting credit upon my chapter and community. Any violation of this code of conduct may result in the participant being sent home at his/her parents’ expense. The Regional Director has the sole discretion to send a participant home.
Signature Of USY’r:
I ,____________________________________, the parent/ guardian of _______________________________, a minor, who will be participating in the regional programs of (HaNegev) USY, do hereby certify that I have read the Code of Conduct set forth above. I do hereby agree that if my child who has signed the above Rules of Conduct fails to adhere to the Code, then in such event those persons in charge of the program may send my child home at my expense. I understand that the Regional Youth Director has the sole discretion to send my child home.
I have been made aware of the fact that the events in which my child is participating may be photographed by either amateur or professional photographers, which the photographs taken may be used both for purposes of reporting on the event or for such other use as the (Region) USY organization may determine. I have no objection to the pictures taken being used at any time for promotional use. It is my understanding that by signing this document I consent to the use of the pictures just referred to for any purpose whatsoever.
The minor has my consent to attend and to participate in the scheduled activity. There are no limitations or restrictions of any kind whatsoever on such participation unless this box q is checked with explanation attached to this page. You are expressly authorized to engage appropriate health care providers to administer, prescribe, and/or direct the administration of any medication, other medical treatment, care, surgery, hospitalization or medical procedures and services deemed appropriate under the circumstance, if you are not able to timely contact me for instructions, acting as my authorized agent and at my sole cost and expense. There are no exceptions or limitations, or other special instructions, in connection with the foregoing, unless this box q is checked with explanation attached to this page.
Unless this box q is checked and I have provided you with specific instructions, directions or other specific data to the contrary, as indicated on this application, you may assume that the minor has no medical disabilities, allergies or other limitations of any kind whatsoever that might in any way limit participation in the scheduled activity. I am aware that this form may be photocopied for use by medical caregivers.
Signature of Parent/Legal Guardian:______________________ PRINT NAME: ___________________DATE:_________
As is written in the dress code adopted by the National Youth Commission:
Tzniut (modesty) is a long-standing Jewish value. As a people who sees ourselves as reflecting the image of God, our Jewish community believes we should act accordingly; thus, some things are not appropriate, for they do not reflect our Jewish values. How we dress is a basic example of these values.
The sections below outline HaNegev Region’s Dress Code Policy. The policies stated in the national code along with input from various youth directors, youth commission chairs, and the regional office have been incorporated to develop this regional set of standards.
A. The following is not permitted in HaNegev Region by males or females in USY or Kadima:
B. The following is not permitted for Shabbat Morning for USY and Kadima:
C. The following is required appropriate clothing for Shabbat Morning:
Females
D. The following is permitted for Shabbat Mincha for USY and Kadima:
E. The following is required for those wearing Kippot for USY and Kadima:
F. The following are considered inappropriate clothing for dances:
1. Shorts which do not appropriately cover the derriere
2. Tank tops, bare midriff styles, halter tops, see through blouses, strapless tops, backless tops, and undershirts worn as an outer shirt
3. Clothing on which any profanity or inappropriate language, pictures or symbols are written, printed or depicted
4. Visible underwear
5. Mini skirts
In addition:
The Regional Youth Director may determine that because of weather, location or event, or nature of the activity, certain variations to these standards may be permitted. All chapter youth directors and staff are required to uphold these standards at all regional and sub-regional events. The regional office gives permission, to chapter youth directors, to use their judgment to deny participation to a sub-regional or regional function to any USYer or Kadimanik who is inappropriately dressed.