Chabad of Calabasas Hebrew School

Chabad of Calabasas Hebrew School

Enrollment Form 2022/2023 - 5783

Child's Information

Child's Name

Child's Hebrew Name

Birthday

School Attending

Grade

My child's knowledge of basic Judaism is:

Poor Fair Good

My child:

does not read Hebrew recognizes the Alef-Bet reads Hebrew slowly reads Hebrew well

Family Information

Are all the child's biological parents and grandparents Jewish?

Yes No

If no, please explain:

Have there been any conversions or adoptions in the family?

Yes No

If yes, please explain:

Parents Information

Father's Name

Mother's Name

Preferred Address

City/Zip

Father's Cell Phone #

Mother's Cell Phone #

Preferred Email Address(es)

Emergency Contact (other than yourself)

Relationship to you

Home Phone #

Cell Phone #

Does your child(ren) have any allergies (food, medication etc.) that we should be aware of?

Is there anything else you would like us to know about your child/ren and/or your hopes for his or her Hebrew School experience?

Hours: Sundays, 10am-12pm

Please consult the Hebrew School annual calendar (to follow) regularly for off-days.

Annual Tuition: $775.00 per child (includes registration & book fee) + $200 security guard fee per family.

***

In the event of an emergency, Chabad of Calabasas has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad of Calabasas has my permission to use my child(ren)’s photo in its publicity materials.

I have completed the Enrollment Form and the information submitted is true and accurate to the best of my knowledge. I have enclosed my payment.

COVID-19 Liability Release Waiver:

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:

I am aware of the existence of the risk on my physical appearance to the venue and my participation to the activity of Chabad of Calabasas Hebrew School that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.

Following the pronouncements above I hereby declare the following: I am fully and personally responsible for my own safety and actions while and during my participation at Chabad of Calabasas Hebrew School and I recognize that I may be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge Chabad of Calabasas, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me or my family members related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless Chabad of Calabasas from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19. My parent must sign this on my behalf if I am a minor under 18. By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that my parents will be signing on my behalf if I am a minor under 18 years old; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.

Electronic Signature

Clear