PARENT #2 INFO

PLEASE SELECT DAYS AND HOURS YOUR CHILD WILL ATTEND ECC BY CHECKING A BOX BELOW

ANNUAL REGISTRATION FEE PROCESSED BY MARCH 15, 2025

NON-REFUNDABLE ANNUAL SECURITY FEE: $672 ($336 IN JULY + $336 IN JANUARY)

NON-REFUNDABLE ANNUAL REGISTRATION FEE: $250 FOR TKA MEMBERS$300 FOR NON-MEMBERS

I hereby assume all risks (including injury or illness) for my child and family members that may occur during participation in any activity or use of facilities owned or rented by Temple Kol Ami. I further agree that I will not hold Temple Kol Ami or the Early Childhood Center and its employees, representatives, volunteers, and agents responsible for any lost or damaged

belongings or for any injury or illness my child or family members may sustain. I understand and agree that I will be financially responsible for any injury or illness my child or my family members may sustain at any Temple Kol Ami or Early

Childhood Center facilities or activities.

I have read and executed the Coronavirus/COVID-19 Assumption of Risk & Waiver of Liability form. The

Coronavirus/COVID-19 Assumption of Risk & Waiver of Liability form is included in this PDF file as the last page of the

In case of sudden injury or illness, I hereby give authority to any hospital or doctor to render immediate aid as may be

required for my child/children's health and safety.

I agree to have the ADHS Emergency, Information and Immunization Record on file at the TKA Early Childhood Center prior to my child's first day of school. Immunizations are required and I will provide notice of updated immunizations.

I give permission for my child to walk to any of the Temple's buildings for all Shabbat Services & Special Events and to

participate in water play on the Temple Kol Ami Splash Pad.

Temple Kol Ami ECC has my permission to apply sunscreen (provided by me) to my child while in their care.

Temple Kol Ami ECC has my permission to apply diaper cream (provided by me) to my child while in their care.

I give permission for my child's photograph to be used by Temple Kol Ami ECC in collateral including but not limited to

Classroom Shabbat letters, Temple Kol Ami websites and brochures, Temple Kol Ami social media, submissions to Jewish

News and other local publications.

Registration form must be accompanied by the non-refundable registration fee. By signing this agreement, I understand

that school year tuition is a 10-month commitment based on 10 equal payments. Payment must be made by automatic deduction from checking/savings or credit card. The first payment is due by July 31, 2025. I understand that I am responsible for a 4-week written notice and payment for that 4-week period in the event that (A) my child will not begin

pre-school on the agreed-upon date; or (B) I withdraw my child from the ECC.

NOTE: 4% FEE ON ALL CARD TRANSACTIONS

10% SIBLING DISCOUNT (DISCOUNT APPLIED TO THE LOWEST TUITION/S)