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Bnei Mitzvah Program

B'nai MITZVah program

registration form

BR and its representatives take great effort and precautions to assure the safety and welfare of your child. In the event of a health-related incident we will contact you immediately at the phone numbers you provide below. The undersigned understands, agrees, represents and warrants to BR that: 1. I am the parent or legal guardian of the child/children listed below. 2. BR, its directors, officers, employees and volunteers shall not be responsible for any and all claims for damages arising as a result of any accident, injury or otherwise sustained by the child/children arising from participation in any BR activities. 3. I permit my child/children to participate in each BR activity(s) that she/he/ they attend(s). 4. BR officials may act on my behalf in case of emergency. 5. Any special medical issues, allergies, special needs or other concerns that BR ought to be aware of are listed in the above registration form. By checking this box you confirm that you, as a parent/guardian of the child/ren, have read and agree to the terms and conditions above.
Beit Rayim Synagogue and School may take photographs or videotapes for use in promotional materials. We do not post names with the pictures. Please indicate if you agree to this for your child(ren) by checking the box below. By checking yes, you give your consent for photographs or videotape of you and/or children child(ren) to be used by Beit Rayim Synagogue and School for promotional purposes. By selecting No,you do NOT give consent for photographs or videotape of you and/or your child(ren) to be used by Beit Rayim Synagogue and School for promotional purposes.
Please indicate if your child has any allergies or medical conditions that require our attention.

 

Mon, October 14 2019 15 Tishrei 5780