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Welcome to the Congregation Serving
the communities of Fairfield County and beyond since 1967
Home Newsletter (opens pdf file in new window) Members' Discussion Forum Invitation to Membership and High Holidays Membership Form Children's Sunday School Adult Ed Directions Other Links at bottom of page |
Congregation for Humanistic Judaism
CHJ Sunday School Medical Release Form
I am leaving the child/children named in this Registration Form in the charge of the Congregation for Humanistic Judaism's Sunday School.
I hereby grant permission for my child/children to participate in all activities of the school.
I hereby grant permission for my child/children to leave the school premises under the supervision of teachers and chaperones for field trips which I have received previous notification.
I hereby give my permission for my child/children to get any medical or surgical assistance that is necessary while the CHJ Sunday School is in charge of their care, if I cannot be reached.
| ___________________________________ |
_____________ |
| Signature | Date |
Medical Information
Insurance:______________________________________________________
Hospital of choice:_____________________________________________
| Child Name | Allergies | Pediatrician | Phone |
| _____________________ | ___________________________ | _____________________ | __________________ |
| _____________________ | ___________________________ | _____________________ | __________________ |
| _____________________ | ___________________________ | _____________________ | __________________ |
Photo Release
I give permission to CHJ to use photographs of my child/children taken at school activities, with captions, to be used and /or reproduced by CHJ for publicity purposes without further consent of the child/children or parent(s).
_____________________________________
Signature
