Youth Group

The Dix Hills Jewish Center and the Youth Group will photograph and video tape members for advertisements, newsletters, media, and slideshows. By signing below, you are authorizing and granting permission to the Dix Hills Jewish Center and the Youth Group to take photographs, video and digital images of your child and grant permission for these photographs to be posted at the temple, and published and/or distributed in newsletters, advertisements, media, slide shows and other outlets for the purpose of communication, marketing, and public relations.
(If you wish to opt out you must provide a letter in writing specifying your choice to opt out before your child begins youth group)

By submitting this form, I accept and understand that as a member of the Dix Hills Jewish Center Youth Group, my child must follow the rules and regulations set forth by the Dix Hills Jewish Center and United Synagogue of Conservative Judaism. Any infraction of such rules and/or regulations may result in a suspension or expulsion from the youth group program. Furthermore, I understand that in the unlikely event of an emergency, every effort will be made to try to reach me and/or the person I listed as my emergency contact. If neither of us can be reached, I authorize the staff members of United Synagogue Youth and the Dix Hills Jewish Center to act as our agents. I give consent to any medical or surgical diagnosis and/or treatment or hospital care deemed advisable by a duly licensed physician; in the event such help of an emergency nature becomes necessary. In no event will United Synagogue Youth, the Dix Hills Jewish Center, its officers, staff, or agents be held liable for any first aid or surgical procedures performed pursuant to this consent.