In the event of an emergency, KI will try to contact a parent or guardian. If they can not be reached, we will try the emergency contacts (emergency contacts must live in the greater Los Angeles area).
EMERGENCY CONTACTS MAY NOT BE PARENTS - THESE SHOULD BE ADDITIONAL PEOPLE WHO MAY BE REACHED IN CASE OF AN EMERGENCY.
In the event of an emergency, we will make every effort to contact the parents or designated emergency contacts.I(We) the undersigned, parent(s)/guardian(s) of the below stated, do hereby authorize Kehillat Israel as agent(s) for the undersigned to consent to any emergency, x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable by, and is rendered under the California Medical Practice Act by the medical staff of a licensed hospital, whether such examination, diagnoses or treatment is rendered at the office of said physician or at a said hospital. It is understood that this authorization is given in advance of any specific emergency examination, diagnoses, treatment, or hospital care being required, and is given to provide authority and power on the part of my(our) above stated agent(s) to give specific consent on any and all such examinations, diagnoses, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable pursuant to the provisions of Section 6910 of the Family Code of California.I/We hereby authorize any hospital which has provided treatment to the above named minor pursuant to the provisions of Section 6910, of the Family Code of California to surrender physical custody of such minor to my/our above named agent(s) upon the completion of treatment. This authorization is given pursuant to the Section 1283 of the Health and Safety Code of California. I/We also release Kehillat Israel and their representatives for all responsibilities of mishaps which may befall the above named individual.Specifically, in consideration of the opportunity to attend all scheduled activities with Kehillat Israel’s religious school and/or youth program, I agree for me, my child, and my spouse to release, indemnify and hold harmless Kehillat Israel ("KI") and its affiliates officers, directors, representatives, agents and employees and all other persons or entities acting in any capacity on KI’s behalf (the "Released Parties") from, and agree not to sue the Released Parties for, any claims that I or my child may have arising from, or in connection with, any personal injury, bodily injury, mental anguish, emotional distress, physical, property or other damage that I or my child may suffer from any cause whatsoever related in any way to my participation in this KI religious school and/or youth group activity, including securing medical treatment for my child. Without limiting the generality of the foregoing, I release, indemnify and hold harmless the Released Parties from, and agree not to sue them for any personal injury, bodily injury, mental anguish, emotional distress, physical, property or other damage that I or my child may suffer from the Released Parties’ negligence arising from or related to my child’s participation in the religious school and/or youth group activity, including travel thereto and KI’s securing or authorizing medical treatment for my child. These authorizations shall remain in effect for this student from September 11, 2016 until June 4, 2017.
I give permission for my child to attend all scheduled activities with Kehillat Israel’s Religious School and/or KI Youth. I understand that Kehillat Israel Religious School and/or Youth will provide adequate supervision for all onsite (synagogue) and offsite events (field trips, retreat facilities, Brandeis Bardin), and that Kehillat Israel will make every reasonable effort to ensure the safety of all participants. However, I am aware that as a non-profit organization, Kehillat Israel cannot, and will not assume responsibility for any accidents or loss of personal effects at any event. I hereby release Kehillat Israel from any liability whatsoever which may arise as a result of transportation to and/or from events, for any injury to my child during events, and waive any claim that hereafter may arise, specifically not to sue or bring action against Kehillat Israel or its representatives.
I/We certify that the above named individual is physically able to participate in the Religious School of Kehillat Israel and/or KI Youth and release Kehillat Israel and their representatives from any and all liabilities whatsoever which may arise from his/her participation in the Programs of Kehillat Israel.
It is my further understanding that the above named individual will observe all the rules and regulations as stated by the Staff of Kehillat Israel and other authorized representatives and that failure to comply will serve as a basis for ejection from the group without refund.
I hereby grant Kehillat Israel permission to use photographs without the name of my child on the Kehillat Israel Website, KI News or other media, KI's closed Facebook page, Twitter, Instagram, a members only Shutterfly account and promotional materials. (Followers are approved by Rabbi Carrie Vogel and the JEC professional staff to ensure only JEC families have access.) I understand that it is my responsibility to inform Kehillat Israel in writing of any change to this permission.
There are two ways to volunteer in the school:
1. One time, drop off opportunities (for example: bringing a dish for the teacher orientation breakfast).
2. One time opportunities in your child's classroom (for example: running a station during the second grade Israel program).
If you are able to volunteer in one of these ways, thank you!
In order for your registration to be processed, it is required for you to be a congregant in good standing. This means that all of your financial committments to Kehillat Israel for the past year(s) are paid in full (or special arrangements made with the Membership Coordinator) and that your membership renewal for 2016-2017 is current.
Refunds will not be issued after the first day of class.
There are four options for payment:
1. Pay with a check (see check prices on blue sheet in JEC brochure). Registration will not be considered submitted until a check is received.
2. One credit card payment (within 48 hours)
3. Semi-annual: Two credit card payments (within 48 hours and again on 12/28)
4. Four payments: Four credit card payments (within 48 hours and again on 10/1, 12/4 and 3/1)
Families of teens: If your child participates in more than one program (yay!), please select one below and click here to select the other programs they will participate in. Thank you and apologies for the inconvenience!
Thank you for submitting your registration form for the 2016-2017 school year. You will receive a confirmation email within 48 hours confirming your enrollment.
Please remember that you need to
submit one form for each child. Thank you!