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Ruth & Lewis Davis Religious School Registration 2020-2021

Please complete the below registration form.

Please email copy of most recent vaccination form to office@shaareikodesh.org
Please fill in medical insurance information.

FAMILY CONTACT INFORMATION


PROGRAM OPTIONS

 

 


EMERGENCY CONTACT AND PICK-UP INFORMATION
In addition to guardians, please list two (2) emergency contacts/authorized individuals for pick up:
APPLICATION FOR ENROLLMENT AND LIABILITY RELEASE

I hereby submit registration for my child, as listed above, for the Congregation Shaarei Kodesh (CSK) Religious School Program during the 2020-2021 school year. I understand that session and class placement of my child is left to the discretion of the Director.  In the event of an emergency, I give permission for my child to be brought to the nearest medical facility and authorize the representative of Congregation Shaarei Kodesh to select a physician, nurse, paramedic or emergency medical technician licensed by the State of Florida, and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which he/she feels are in the best interest of my child.  This form also serves as a release form for any trip on which my child participates during the school year. I also, hereby release and agree to defend, indemnify and hold Congregation Shaarei Kodesh (and its officers, directors, agents, volunteers and employees) harmless from any and all damages, injuries, claims and causes of action arising (directly or indirectly) out of my or my child’s participation on any school-sponsored activity or trip. My child has my permission to participate in all activities of the Education Program for which he/she is registered.


By signing this application, the undersigned agrees to pay the total amount of tuition and fees for the 2020-2021 school year.  In the event of payment default, CSK reserves the right to cancel the student’s enrollment and the undersigned agrees to pay the expenses of enforcement and collection, including attorney’s fees and costs.
Fri, December 4 2020 18 Kislev 5781