USY Youth Group Registration 2019-2020
Sababa United Synagogue Youth (USY) is the high school youth group of Temple Beth El in Rochester, New York, under the auspices of the United Synagogue of Conservative Judaism (USCJ) and Tzafon Region. USY inspires Jewish teens to explore, celebrate and practice ethical values, Jewish living, Zionism and community responsibility based on the ideology of the Conservative movement.

Temple Beth El’s chapter, Sababa, has embodied these values and vastly contributed to our community since its inception. Sababa provides many social, educational, community service, and leadership opportunities for our Jewish youth. The USY membership fees cover chapter, regional, and international dues and help to offset the cost of some chapter events. Regional and International USY programs will be organized and have a separate charge.

The annual membership fee is $36 for TBE members and $50 for non-members.
Please make checks payable to: TBE Youth Groups
Please don’t hesitate to contact the education office with any questions. 585-473-1190
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Email *
About USYer
USYer's First Name *
USYer's Last Name *
Street Address *
City *
Zip Code *
Gender *
Graduation Year *
Date of Birth *
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/
DD
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USYer's Cell Phone *
Parent Info
Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Phone number *
Best email address for parent correspondence: *
Parent 2 First Name
Parent 2 Last Name
Parent 2 Phone Number
Best Email Address for correspondance:
Payment Info
Check ONE (1) of the following. Please make checks payable to "Temple Beth El" *
If you feel there is anything we should know regarding your child (medications, conditions, allergies, dietary preferences, etc.) in case of an emergency please leave that information below: *
Emergency Contact
In case of an emergency, whom shall we contact if parents are unavailable?
Name *
Relationship *
Phone Number *
Physician: *
Phone Number *
Health Insurance Provider: *
Identification Number: *
Liability Consent
I certify that the above information is correct and that my USYer is in proper physical condition to attend youth group programs. I hereby give permission for my USYer to participate in all trips and activities sponsored by United Synagogue
Youth whether they be arranged by Temple Beth El and/or the Tzafon regional office. I hereby release United Synagogue Youth, Temple Beth El, and Sababa USY from any liability in case of accident or occurrence en route to or from and/or throughout an event. In case of emergency, I hereby give permission to the physician selected by the regional advisor or chapter advisor to hospitalize, secure proper treatment for, and/or order injection, anesthesia or surgery for my child, as named above, if I cannot be reached and such care is deemed medically necessary by the physician
By selecting "Yes" I consent to the above statement. *
Typing my name below stands as my legal signature for the above statement. *
Photo Release Consent
I hereby grant permission for films, video, and/or audio tape recordings, slides and photographs (collectively “Media”) to be taken of my son/daughter by Temple Beth El personnel during USY programs and volunteer activities for purposes of promoting Temple Beth El and/or its USY program. I authorize Temple Beth El to use my son/daughter’s image on its website and/or in other official synagogue and/or USY publications without further consideration, and I acknowledge Temple Beth El’s right to crop or otherwise treat the Media at its discretion.
I also understand that once my child’s image is posted to the Temple Beth El website or other USY related websites, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold Temple Beth El and USY harmless from any claims related to the permitted uses under this Photo Release.
By selecting "Yes" I consent to the above Photo Release statement. *
Typing my name below stands as my legal signature for the above statement. *
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