CBI Religious School Questionnaire 23-24

Thank you for registering your child(ren) for Congregation B'nai's Israel Religious School! We are so happy to have you join us for another year of learning and community. We need just a little more information to get us all set up for a successful year, so please take a few minutes to fill out this form. Thanks!

Please, feel free to reach out to be should you have any questions at all.

L'Shalom,

Samantha Hoffman
Director of Family and Community Learning

* Parent (1) First and Last Name

* Parent (1) Email:

* Name(s) of child(ren) you registered for Religious School

Parent (2) First and Last Name

Parent (2) Email:

Student Information

* Do any of your children have an IEP/504 plan you would like to share with us?

If you select yes, Samantha Hoffman, Director of Family and Community Learning, will reach out to find out more information.

* Do(es) any of your child(ren) have any allergies/medical conditions we should know about?

Please list which child and what their allergies/medical conditions are.

Emergency Release

Please list two emergency contacts that we can reach out to in the event parents cannot be reached.

* Emergency Contact 1: Name

* Emergency Contact 1: Relationship

* Emergency Contact 1: Phone Number

* Emergency Contact 2: Name

* Emergency Contact 2: Relationship

* Emergency Contact 2: Phone Number

Carpool Release

I/we give permission for the following adults to pick up my child(ren) from Religious School.

* Name(s)

Relationship

* Name(s)

Relationship

Photo Release

There are several way that your child(ren's) photograph's may be used at Congregation B'nai Israel. Please state your preferences below:

I give permission for my child(ren)'s picture (no names) to be used on the CBI's website and social media.

I give permission for my child(ren)s picture to be used in print advertising materials, brochures, etc.

I do not give permission for my child(ren)'s picture to be used in any capacity.

Student Medical and Liability Release

Please click here to read the Medical and Liability Release. Once you have read it please type your name below giving Congregation B'nai Israel Medical and Liability Release to care for your child in case of emergency.

* Parent 1: I accept the terms of the Medical/Liability Release

Parent 2: I accept the terms of the Medical/Liability Release

Date

Insurance Company and Policy Number

Name of Child's Physician

Physician's Phone Number

Sun, May 19 2024 11 Iyyar 5784