Leave this field empty

GOHTY-Kids 2019-2020

Youth Group Registration
Grades 5-7

MM/DD/YYYY

Parent/Guardian Information

Parent/Guardian #1 information

Parent/Guardian #2 information

Emergency Contact

*** Must be someone different than who was listed above

Aunt, Uncle, Neighbor, etc...

Medical Information

Allergies, asthma, significant conditions. If nothing notable, just write "None."

Kosher, vegetarian, food sensitivities/allergies

In case of medical or surgical emergency, I understand that every effort will be made to contact parents or guardians of youth group members. In the event that the family cannot be reached, I nearby give permission for the Youth Director/the Director's designee to secure all proper medical treatment for the youth group participant. I release Congregation Gates of Heaven and its designees from all responsibilities other than supervision of activities.

By writing my name, I hereby agree with the above statement.

Brit Kehillah - Code of Conduct

- Synagogue property is not to be abused or damaged in any way.

- Leave a youth group activity without the permission of the Youth Director is strictly prohibited.

- NO DRUGS, ALCOHOL, OR ANY OTHER ILLEGAL SUBSTANCES are permitted at any youth group functions.

- Guests are allowed at youth group functions only with the permission of the Youth Director. Unauthorized guests will be asked to leave the event.

- Violation of these rules and/or laws may result in suspension from future youth group activities and/or legal action if warranted.

- All members will agree to refrain from any inappropriate sexual behavior.

- All members will abide by any additional rules, pertinent to a specific event, which may be announced, and will accept the consequences of their violation.

I have read the Birt Kehillah (Code of Conduct) and agree that the member will abide by its terms and conditions. I understand that any infraction or violation of the Brit Kehillah may result in immediate expulsion from an event and/or membership at the expense of the parent/guardian.

By writing my name, I hereby agree with the above statement.

Payment

Membership Dues are $45. You may pay online by check or credit card. If you choose to pay in person/send a check into the office, please make all checks payable to CGOH, Memo: GOHTY-Kids, and select the appropriate payment option below.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.
Total:   

For added Security please check the box below.