Family Packet

Emergency Contact #1 (should be different than the parent/guardian)*
Emergency Contact #2 (should be different than the parent/guardian)*
Primary Doctor*
AUTHORIZATION FOR EMERGENCY TREATMENT: In case of an emergency where I cannot be reached, I hereby authorize Mill Basin Yeshiva Academy to arrange for appropriate immediate medical attention for my child/children at the nearest medical facility (doctor, hospital, etc).*

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Medical Information*

PARENTAL REQUEST FORM 2023-2024: NEW YORK STATE TEXTBOOK LAW (NYSTL), SOFTWARE LAW (NYSSL) LIBRARY (NYSLIB), (COMPUTER HARDWARE), (NYSCH): I hereby authorize the school to obtain state-loaned textbooks, software and library books, and computer hardware for my child/children (children listed on page 1 and 2) pursuant to the New York State Textbook, Software, Library, and Computer Hardware Law.*

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PERMISSION SLIP: I hereby grant permission for my child/children to accompany his/her teacher and other supervisory personnel, where necessary, on neighborhood walks at any time during the 2023-2024 school year.*

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CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR SCHOOL USE (e.g. educational, public service, marketing or health awareness purposes): I give permission for my child/children to be photographed and/or videotaped throughout the school year at various performances, ceremonies, and numerous holiday events. I understand that these photographs will be used on social media and various other places.*

YesNo

Please click the link below to view the student Handbook

Student Handbook 2023
I, the parent and guardian of the children listed above, confirm that I have read and agreed to the rules and conditions in the student handbook. I also confirm that everything in this packet is true. I will notify the school with any changes or updates through e-mail or written & signed letters.
Parent/Guardian Signature*

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Today's Date*

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