The Religious School of Temple Kol Ami 2020-2021

The Religious School of Temple Kol Ami

Registration Form 2020 - 2021
Student Name #1: *

First Name Last Name
Hebrew Name:
Date of Birth: *

Month Day Year
CURRENT GRADE: *
student Name #2:

First Name Last Name
Hebrew Name:
Date of Birth:

Month Day Year
CURRENT GRADE:
Student Name #3:

First Name Last Name
Hebrew Name:
Date of Birth:

Month Day Year
CURRENT GRADE:
Mother Name: *
Phone Number *

Area Code Phone Number
Father Name: *
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Does your child have any allergies or medical conditions?:
Please provide any additional information about your child that would be helpful:
EMERGENCY CONTACT #1: *
Name and Contact Number
HOW CAN YOU ASSIST AT TKA RELIGIOUS SCHOOL AS A VOLUNTEER?:

Hebrew Ed Teacher Substitute Teacher Hebrew Tutor Classroom Assistant Parent Volunteer

The Religious School of Temple Kol Ami

Tuition Agreement 2020-2021
Name: *

First Name Last Name
E-mail: *
torah tots @ $125/student:
tka member students @ $300/student:
tka Non-member students @ $600/student:
***Additional fees for B'nai Mitzvah to be determined individually.
Total tuition due: *
I agree to all fees and dues associated with the Religious School Of Temple Kol Ami for the school year beginning 9/2020 and ending 5/2021. I agree all tution and fees must be paid in full by 9/13/2020 unless other arrangements have been made.

Please print and sign below.
print signature: *
Signature: *

You may use your mouse or touch screen to sign your name. Clear
Date: *

Month Day Year

The Religious School of Temple Kol Ami

Liability Waiver and Photo Release 2020-2021
SPONSORED BY TEMPLE KOL AMI, 1691 SC-160, Fort Mill, SC

Print or type all information clearly. This form is required for attendance and should be used along with any other liability form required. Participants 18 and over may sign for themselves. If the participant is under 18, at least one legal guardian must sign.
STUDENT(S) NAME: *
LIABILITY RELEASE

The undersigned do hereby release, forever discharge and agree to hold The Religious School or Temple Kol Ami harmless from and against any and all liability, claims, demands, lawsuits, and expenses arising from personal injury, sickness, death, or property damage of any nature whatsoever which may be incurred or suffered by the undersigned and/or the participant (If participant is under 18, or 18 and older) while attending religious school and activities sponsored by such. Furthermore, the undersigned hereby assume all risk of personal injury, sickness, death, damage and expense arising from the undersigned’s and/or participant’s (if participant is under 18, or 18 and older) participation in all activities, including recreation and work activities involved in the above activity. In addition, authorization and grant permission is hereby given to furnish all necessary transportation and food for the undersigned and/or participant (if participant is under 18, or 18 and older). I(we) release The Religious School of Temple Kol Ami and Temple Kol Ami the above named and the site organization(s) of all responsibility and consequences that may arise as a result of injury suffered and resulting treatment. The undersigned further hereby agree to indemnify and hold The Religious School of Temple Kol Ami and Temple Kol Ami and the site organization(s) and their respective members, directors, employees, and agents (collectively, the ‘Indemnities’), harmless from and against any and all claims, demands, actions, lawsuits and liabilities, including attorney’s fee and expenses sustained by the Indemnities as the result of the negligent, willful, or intentional acts of the undersigned and/or participant (if participant is under 18, or 18 and older). If participant is now and will be under 18 years of age at the time mentioned above: I (We) are the parent(s) or legal guardian(s) of the participant, and hereby grant permission for SEE NAMES PRINTED ABOVE to participate fully in the above activity and all of its undertakings, and hereby give our permission to take said participant to doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery; and, we fully and completely assume responsibility for all medical bills. I also give my permission for CPR and firstaid to be administered if deemed necessary. Furthermore, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) assume all responsibility and transportation costs. Through me, the minor agrees to abide by all rules and regulations stated by The Religious School of Temple Kol Ami and Temple Kol Ami, the site organization, and the staff.
PHOTO RELEASE

I(We) give permission for images (If participant is under 18, or 18 and older) captured during the above activity through video, photo, and digital camera, to be used solely for the purpose of The Religious School of Temple Kol Ami and Temple Kol Ami’s website, Facebook sites, and promotional material and publications, and waive any rights of compensation or ownership thereto. I agree that minors’ names will not be listed without my consent.
print signature: *
Signature: *

You may use your mouse or touch screen to sign your name. Clear
Date: *

Month Day Year
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