103 School Road West
Marlboro, NJ 07746
Phone: (732) 536-2300

Youth Code of Conduct Form


NAME:______________________________________________         BIRTH DATE:____________________________________


PARENT’S TELEPHONE #_____________________________    PARENT CELL#___________________ ________________

INSURANCE CO.: _____________________________________ POLICY NUMBER:__________________________________

EMERGENCY CONTACT (NOT A PARENT) & PHONE NUMBER:_______________________________________________


Please provide details for applicable items pertaining to your child.

Allergies (Food, drug, insect or substance) __________________________________________

Current Medication(s) or Medical Treatment_______________________________________

Recent illness, injury or surgery__________________________________________________

Disability, chronic illness or condition_____________________________________________

Activity restriction or modification________________________________________________



I (the parent or legal guardian) of the applicant state that he/she is in good/normal health has no physical or mental handicaps that would interfere with full participation in the program and has my permission to engage in all available activities except as noted under Restrictions or Modifications above. 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 that the photographs taken may be used both for purposes of reporting on the event or for such other use as the Marlboro Jewish Center Youth 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.

In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parent(s) or guardian(s) of the participant, or the emergency contact person listed above. In the event I cannot be reached, I hereby give permission to the physician selected by the Marlboro Jewish Center Youth Director, or his/her designee, to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia, or surgery for my child as named above. I am aware that this form may be photocopied for use by medical caregivers.

SIGNATURE OF PARENT OR LEGAL GUARDIAN_____________________________________________

PRINT NAME:_____________________________________ DATE:___________________________________




In connection with any Regional program (including dances), including travel to and from such program:

  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 possession or consumption of any alcoholic beverages.
  4. There will be no shoplifting or any other theft of any kind.
  5. If a USYer/Kadimanik is caught in possession of/or using alcohol or illegal drugs, he/she will immediately be sent home at his/her parents’ expense. Furthermore, USY International policy states: “Anyone violating any such rules at a regional event for the infraction of these rules is barred from International events for one year following the infraction.

These events include (but are not limited to) the International USY Convention and USY summer programs. “The Region reserves the right to impose additional sanctions in connection with this or any other improper behavior as it sees fit.

  1. Each participant is expected to maintain proper decorum and attitude during the entire program. Disruptive behavior (including, among other things, inappropriate sexual behavior) will not be tolerated. Your parents will be responsible to pay for any damage you may cause.
  2. No attendee may leave the facility except at those times specified by the schedule.
  3. Each participant is expected to conduct him/herself appropriately as a Conservative Jew (including through the observance of Shabbat and Kashrut, in accordance with applicable standards of the Law and Standards Committee of the Rabbinical Assembly and/or the local Rabbinical Authority.
  4. The USY or Kadima Director, in consultation with the Regional Youth Commission, reserves the right to enforce other rules relating to the integrity of the Regional Youth Program and/or the health, safety or welfare of its participants.
  5. 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. USY or Kadima Director, in consultation with the Regional youth Commission, reserves the right to enforce other rules relating to the integrity of the Regional Youth Program and/or the health, safety or welfare of its participants.

I have read these rules and understand them fully. I certify that I will adhere to this Code and will conduct myself in a manner reflecting credit upon chapter, my congregation, community and myself. 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 PARENT                                                  SIGNATURE OF USYer/Kadimanik