This information is being requested in order to better serve our students. It will be kept confidential and shared only with necessary staff members. If there are no issues, please type N/A in the answer field.

Medical Release:  Please select one: "I AGREE" or "I DISAGREE"

In the event of an emergency, I hereby give qualified medical personnel permission to secure proper treatment for my child, including, if necessary, hospitalization. I understand that I will be contacted immediately in such a case.

Photo Release:  Please select one: "I AGREE" or "I DISAGREE"

Do you allow the use of pictures of your child(ren) to appear in the following (names and other identifying information will not be used):

Learning and Engagement Center Facebook page or other publicity materials for educational and advertising purposes.

The weekly LEC newsletter is distributed to school families and select synagogue members only.

Images may also be used in various CAS Synagogue Publications (monthly bulletin, weekly email, or CAS website). 

E-Signature: FIRST NAME, LAST NAME

By typing your name below you are indicating that you have read and agree to all of the above.

Congregation Ahavath Sholom does require that you have an up to date family membership.

There may be some additional fees for additional activities, such as field trips or a program that is outside of our usual programming.

I agree to the above conditions/statements/policies and promise to pay all tuition, membership, and fees as stated.