If student is 9th-12 grade, please provide their e-mail and cell phone:
Occasionally an emergency arises when it is necessary for a School representative to contact parents when their children are at school. Every effort will be made to notify the parents or someone designated by them if a child should become very ill or be involved in an accident. If this cannot be done, the policy of the Temple is to transport the child to the nearest emergency hospital. This action will be taken in all such cases unless instructions to the contrary are provided by the parents.
It is understood that this authorization is given in advance of any specific examination, diagnosis, treatment or hospital care being required and is given to provide authority and power on the part of our above-named agent to give specific consent to any and all such examinations, diagnoses, treatment or hospital care which the aforementioned physician in the exercise of his/her judgment may deem advisable.
I further grant permission for Congregation Beth Israel to use my child’s image and voice in printed & electronic materials, with the knowledge that no last names will be used on a public document.
Please check "Yes" or "No" to provide your consent.