Swusy Kamp Kadima Application

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Get$25 offSpringKadima Convention at Shearith Israel April 16-18, 2010 ; with paid

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Awesome Programs! Shabbat-USY Style!

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***Qspsellations must be in writing to your chapter Youth

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SOUTHWEST REGION USY CODA OF CONDUCT FORINTERNATIONAL AND REGIONAL USY EVENTS For purposes

offiis

Code of Conduct,

a

"USY event''

or

"activitt' shall include all times fiom when a USYer

leaves his or her home,

fpoughwhen tho USYer retums to his or her home, including free time and during tansporhtion to and fiom dre evenq and all times during hone-hospitality USY events.

1. Kashrut will b€ obsered, including during tansportation t0

and

fiom USY events, and during "ftee tine."

observe the rcligious policies eshblished by the Unitsd Synagogue of Conseriative Judaism, including those pertaining to Shabbat observance (including anival prior to Shabbat and tavel on Shabbat exclusively to a scheduled synagogue evett or servicos); all males must wear Kippot during all services and meals, and TalilrTefillin for moming services, where appropriate , All USYen shall wear clothing appropriate b the event/location.

2. Rellgiour Obneryanoe. All USYers and $affshall

3. Poss€ssion or use of

any weapons, alcohol, tobacco products and/or illegal drugs is not

perurittd at

a

USY event' No

gambling is permified.

4. Tinely rttendance

at all sqheduled USY went activities is

requird

and only those rcgistered for the

UfY

eyent are

prmitted'to attend, unless otherwise approved by the event director. No USYer may leave the premises in u&ich a scheduled ivent is located without prion approval of the event director, as well as prior permission of fte parent/guardian. No USYer shall be pennitted to drive a car to, from or during a regional event'

5. Home Hoopitality. All housing assignments for hone hospitality express permission

are final, and any changes may only be made with the

oitheeventdirictor.-hiorto sclreduled wentg USYenand staffmustEoceeddirectlytotheplaceforfie

schedulid event. Following scheduled events, USYers and sbffmust proceed directly to the assigted home'

6. Camp/Hotet Hospitelity. Males

are not penmitted in sleeping rooms or cabins

permitted in sleeping roomi or cabins occupied by males. Room changes event director, No USYer shall leave his/her room after curfew.

will not

occupid by females,

and females arp not

be allowed without tire pemission of the

7. Observance of Civil/Criminel law. No USYer or staffshall violate any civil or criminal law, includin& but not limited phlnical ancl/or to, ftose related to bmp€ring ofor destuction to property, and desFuction ofoue's own ot another person's nental integity. InApropriate or unwelcome phpical contact or languagg indecent attirc or public nudity, shall not be permitted.

8. Coopeption with Staff,

Each USYEI shall

fully cooperate wittr every shffperson, including volunber staffpersonq and

shall otherwise adhere to all rules established for the event'

9. f,sch USYer shall

be responsible for any damage inouned or for any violation of dre mles

ftat occur in his/her room,

regardless ofthe penon incuning 6ose damages.

Anyonewho violates this Code ofConductshallbe subjectto disciplinryconsequenc€s, including butnotlirnitedtq being senthome property at tle expense ofthe violating USYer or staff member (or his/her parenUguardian), monetary payment for penonal and/or behavioral rules, damages and suspension fiorr future USY events. The event director reserves fte right to enforc,e these and my other heal&, and iipose ad6itional sanctions with respect to behavior that would otherwise affect fre integrity of the USY evmt and/or lhe safely and welfare of its participants and

shff.

other a USYer or shffmember violEtes Se National Youdr Commision policy regarding drug/alcohol abuse or any criminal offense (inoluding but not limited to shoplifting), punishnent for that offense will include suspension ftom international USY eventsiactivities (including but not limited to Intsrndional USY Convention and USY Summer Progan$ for one year following the infraction. Individuals will also be prohibited from participating in dre next major ngional USY program and other

In the event

fiom ohairing events or shffing programs for sk montlrs' Individuals already in leadership por,;tioor would be removed, A major Regional event is a regionally sponsored overnight wen! such as a

events oicuning in the interirn, and prohibited

convention, Kinnus or Encampment Regions may impose additionel sanctions at their discretion.

I

have teEd the soathwifjt Reglon usY code of conducl and

USY€f

SigrdrE

Pr€ntSi$ahm

I

agtee to abide by its

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Registration Fee: fl54 (American)

CHAPTER:

KadimaApplication

Please note the cost does not include transpoltation. A late fee of $30 will be assessed for all late applications

Due Date:

SWUSY Region Camp Kadima October 23-25,2009 Camp Carter - Fort Worth' TX Sex-

HebrewName Address #

City / State )

& Street

Phone(

E-mail Address

Grade_

Bar/Bat Mitzvah parsha

Are you a vegetarian?

Yes

zip Birthday

Ifyes, do you eat chicken? TurkeY? Mom's Hebrew Name

No

Dad's HebrewName

Work Phone

Mother/Guardian

Father/Guardian Parent E-mail Address ln an emergency, notiff

WorkPhoneC )

PhoneC--J---

Medical Insurance Company & Policy Number

Check if being

Current Medication Allergies,

sent-

PhoneL-l-_--

Rooming: Please make sure to write the names of three people (of the same gender) with whom you would like room. Every attempt will be made to room each USYer with at least one of his/her choices. All rooming decisions are final. I would like to be roomed with: Chapter

1.

Chapter Chapter

I

can lead thefollowing semices (please circle):

D'Zimra Shabbat: P'sukei D'Zimra Read Torah Be a Gabbai Weekday: P'sukei

Shaharit

Minha

Maariv

Lead Hamotzi

Shaharit

Minha

Maariv

Kabbalat Shabbat

Lead Birkat

Hamazon

Read

Haftarah Lead Kiddush

My child has my permission to attend the SWUSY Region USY LTL In case of emergency, I give the adult in charge my permission for medical treatment to facilitate immediate emergency action. I hereby authorize the medical personnel to order x-rays, routine tests and treatment for my child, and in the event I cannot be reached in an emergency, I hereby authorize the physician to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child as named above. I understand that I shall be responsible to pay for any medical care rendered to my child while attending this USY firnction.

Parent/Guardian

Signature

Date

PLEASE MAKE SURE BOTH PAGES OF APPLICATION ARE COMPLETELY FILLED OUT!