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Religious School Registration 2018

Please check here if your child does not have a Hebrew name and you want one.

Please select appropriate grade for this student.

AT HOME HEBREW SIGNUP - This will open in a new window so that you can continue with the registration after you have completed the form.

If you checked any allergies, please give us details:  Epi-pen information; if the allergy is inhaled, ingested or from contact; specific medication allergy.  This information is extremely important in the event of an emergency.

Please be specific as this could be important in the event of an emergency.

Some examples would be:  Epi-pen, insulin, inhaler, benedryl, etc.

I understand that I will provide the Religious School with a copy of my students current immunization records.

ALL participants in Pre-K thru 12th Grade programming, including Youth & Family Programming, Religious School and Madrichim, must provide proof of up-to-date vaccinations, in compliance with Delaware Health Codes.

If you want your 8th - 12th grader to be a member of BESTY (the senior youth group), please check here.

Please check here if your child does not have a Hebrew name and you want one.

Please select appropriate grade for this student.

If you checked any allergies, please give us details:  Epi-pen information; if the allergy is inhaled, ingested or from contact; specific medication allergy.  This information is extremely important in the event of an emergency.

Some examples would be:  Epi-pen, insulin, inhaler, benedryl, etc.

Please be specific as this could be important in the event of an emergency.

I understand that I will provide the Religious School with a copy of my student's current immunization records.

ALL participants in Pre-K thru 12th Grade programming, including Youth & Family Programming, Religious School and Madrichim, must provide proof of up-to-date vaccinations, in compliance with Delaware Health Codes.

If you want your 8th - 12th grader to be a member of BESTY (the senior youth group), please check here.

Please scroll down to Family Information if you are not registering any more children.

Please check here if your child does not have a Hebrew name and you want one.

Please select appropriate grade for this student.

If you checked any allergies, please give us details:  Epi-pen information; if the allergy is inhaled, ingested or from contact; specific medication allergy.  This information is extremely important in the event of an emergency.

Please be specific as this could be important in the event of an emergency.

Some examples would be:  Epi-pen, insulin, inhaler, benedryl, etc.

I understand that I will provide the Religious School with a copy of my student's current immunization records.

ALL participants in Pre-K thru 12th Grade programming, including Youth & Family Programming, Religious School and Madrichim, must provide proof of up-to-date vaccinations, in compliance with Delaware Health Codes.

If you want your 8th - 12th grader to be a member of BESTY (the senior youth group), please check here.

Please scroll down to Family Information if you are not registering any other children

Please check here if your child does not have a Hebrew name and you want one.

Please select appropriate grade for this student.

If you checked any allergies, please give us details:  Epi-pen information; if the allergy is inhaled, ingested or from contact; specific medication allergy.  This information is extremely important in the event of an emergency.

Please be specific as this could be important in the event of an emergency.

Some examples would be:  Epi-pen, insulin, inhaler, benedryl, etc.

I understand that I will provide the Religious School with a copy of my student's current immunization records.

ALL participants in Pre-K thru 12th Grade programming, including Youth & Family Programming, Religious School and Madrichim, must provide proof of up-to-date vaccinations, in compliance with Delaware Health Codes.

If you want your 8th - 12th grader to be a member of BESTY (the senior youth group), please check here.


FAMILY INFORMATION

MEDICAL RELEASE

In case of an emergency, the school staff will contact 911.  Every attempt will be made to contact a parent, a guardian, or a designated emergency contact.

This health history is correct and complete to my knowledge.  The person herein described has permission to engage in all program activities except as noted.  I hereby give permission to Congregation Beth Emeth to provide first aid, administer prescribed medications and seek emergency medical treatment including ordering x-rays or routine tests.  I agree to the release of any records necessary for insurance purposes.  I give permission to Congregation Beth Emeth to arrange necessary related transportation for y child.  In the event that I or the designated emergency contact cannot be reached in an emergency, I hereby give permission to the physician/health care provider selected by Congregation Beth Emeth to secure and administer treatment, including hospitalization, for the person named above.  This completed form may be photocopied, if needed for trips.

RELEASE AND ASSUMPTION OF RISK FORM

As used herein, the term "Congregation Beth Emeth" shall include, but not be limited to, Congregation Beth Emeth, or any employee (full-time or part-time) of Congregation Beth Emeth, any volunteer assisting Congregation Beth Emeth, and/or any agent, employee, or licensee or any of the forgoing.  The term "Undersigned: shall be the student involved and the student's parents and/or legal guardians.

The Undersigned understands that during any time in which the student in participating in conjunction with Congregation Beth Emeth, certain risks exist, including, but not limited to, hazards of accidents or illnesses, the forces of nature, personal injuries, theft and/or destruction of personal property, acts of third persons, and travel by automobile, bus, or other conveyance.

In partial consideration thereof, and for the right to participate in this activity and related activities, the Undersigned hereby assumes all the risk set forth above and hereby holds Congregation Beth Emeth harmless from any/all liability, action, causes of action, or related activities.  the terms hereof shall serve as a release and assumption of risks for the Undersigned, their heirs, executors, administrators and family members.

If the student is under the age of majority, the Undersigned agrees to indemnify Congregation Beth Emeth for any liabilities imposed on Congregation Beth Emeth by reason of any claim, cause of action, or charge of any kine brought about by the student's participation, or by any person on behalf of the student and arising out of the above described activity or incidents relating thereto.

The Undersigned further acknowledges that the student will abide by all rules and directives of Congregation Beth Emeth.  Any inappropriate conduct or misbehavior by the student or any violations of the rules, regulations or directives of Congregation Beth Emeth, will result in the student's immediate removal from participation in this activity.

 

My child may be given the following over-the-counter medications (such as headache relief medicine, cough drops, antihistamine, etc.)  We will contact you or your designated emergency contact before giving any medication or treatment, except in the case of any emergency.

PHOTO PERMISSION

From time to time we take pictures during school.  We would like your permission to use these pictures.  We will never reference your child by name or provide any specific information regarding your child.  We also will never sell these pictures; we will use them exclusively for internal purposes and promotional activities (including, but not limited to our website, Facebook page, newsletter, and brochures).

If you do NOT give us permission to use your child's image, please check the box below.  If you do not check the box below, you give Congregation Beth Emeth permission to use your child's image.

Please sign below indicating that all information provided is current and accurate to the best of your knowledge.

Please type first name and last name.

Thu, May 23 2019 18 Iyar 5779