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  • Applicant's Information
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  • Home Address
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  •   Student's Present School (Daytime School)
     
  •   Parent's Information
  • Parent's Information
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  • Parent's Information

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  • DISMISSAL INFORMATION
     
  •   IF PARENTS UNREACHABLE IN EMERGENCY, CALL
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  •   Placement of children in a particular class is at the discretion of our Religious School Principal.   I release Sutton Place Synagogue from all responsibilities other than supervised school activities.   It is understood and agreed that designees of the principal may photograph, film, videotape, audiotape or reproduce written materials of the applicant for use in publications and publicity.   If and when the need for medical and/or surgical attention arises during the period of my child"s official participation in the Jackson Religious School program, I hereby grant permission for my child to be transported by private vehicle or ambulance to an appropriate medical facility and to be treated by qualified medical authorities at their discretion and that of the program leaders.
  • Medical Release Form

  • NON-PRESCRIPTION MEDICATIONS
  • My child has my permission to take the following non-prescription medications:

  • In our effort to create an effective and positive learning environment for our students and classes, please provide the following confidential information.

  • If and when the need for medical and/or surgical attention arises during the period of my child"s official participation in the Jackson Religious School program, I hereby grant permission for my child to be transported by private vehicle or ambulance to an appropriate medical facility and to be treated by qualified medical authorities at their discretion and that of the program leaders.
  • Parent's Signiture
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  • Should be Empty: