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Welcome to the Congregation Serving
the communities of Fairfield County and beyond since 1967
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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
