Please describe allergies and medications as applicable.

Please offer any additional notes on your student that will be worth noting to our educator. Please include any behavioral notes, notes from an IEP if applicable, and best practices from school or home to engage your student. All details will be confidential.

Please describe allergies and medications as applicable.

Please offer any additional notes on your student that will be worth noting to our educator. Please include any behavioral notes, notes from an IEP if applicable, and best practices from school or home to engage your student. All details will be confidential.

Please describe allergies and medications as applicable.

Please offer any additional notes on your student that will be worth noting to our educator. Please include any behavioral notes, notes from an IEP if applicable, and best practices from school or home to engage your student. All details will be confidential.

Please describe allergies and medications as applicable.

Please offer any additional notes on your student that will be worth noting to our educator. Please include any behavioral notes, notes from an IEP if applicable, and best practices from school or home to engage your student. All details will be confidential.

Does the WRJC have permission to include photographs and videos of your student(s) in emails, printed publications, synagogue websites, and social media accounts?

Does the WRJC have permission to provide your student(s) over-the-counter medications as well as to provide transportation to your student(s) to a hospital?

Do you agree to indemnify and hold harmless the WRJC, its employees, and agents for any and all claims and injuries which may occur in connection with your student(s) activities organized by the WRJC, including direct or indirect acts of negligence?

Does the WRJC have permission to provide designated transportation to your student(s) as decided by the WRJC and do not hold WRJC employees or agents responsible for any damage caused by those providing transport?

Does the WRJC have permission to contact your student(s) via cell phone call, text message, letter, or email to receive event invitations, reminders, and updates?

Does the WRJC have permission to apply your selections in this form to future academic years unless you contact us and specify otherwise?

Thank you! We look forward to learning together with your student.