Sign Up for USY Membership 2017-18

Welcome! USY is open to 9th - 12th Grade. 

In order to participate in most USY functions, i.e. Regional Conventions, Jew Ball, the Adath Musical Production, Chapter Membership Retreat, etc. you must pay dues and become an official member of USY. 

Your $90 USY membership dues {$115 for those teens, not Adath Family Members} helps to offset administrative and program costs associated with the Youth Department. 

If you plan to participate in any of these activities throughout the year, please complete this form and pay your dues now.  That way we can be sure to include you on our mailings about conventions, and our fantastic USY programming throughout the year. 

First Parent/Guardian Information

Second Parent/Guardian

Teen Information


Emergency Contact

Emergency contact (other than parents) in case of illness. This person must be able to come and pick up your child.

Photo and Image Release

At many events pictures and videos are taken. I understand these images may be used for Adath Jeshurun Congregation and for scrapbooks, promotional materials, as well as other official purposes, and they may be uploaded to official and unofficial websites and any social media sites. I give Adath Jeshurun Congregation, its membership, and associated organizations permission to use images taken at sanctioned events.