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Preschool B'Yachad Registration 22/23

Congregation Shir Shalom B'Yachad School
Jewish Learning Together

B'Yachad means "Together"

Preschool B'Yachad Registration
(10 Classes)
Please enter your information below and fill in all fields, along with a registration and health form for each child attending B'Yachad school.
Please ensure that this credit/debit card is set up in "My Account" as one of your Payment Methods. We will use this card to pay the above. If paying by check, please select Bill to My Account.

Congregation Shir Shalom B'Yachad School
2022-23 Individual Student Registration Information

Student 1 Information

Student 2 Information

Parent / Guardian Information:
2022/2023 Emergency/ Medical Information 
Student 1 Information
Responsible Parent & Telephone (during Religious school hours)

Student 2 Information

The undersigned does hereby give permission for my child ("child's name") to attend and participate in any Shir Shalom children/youth activities, events, retreats, childcare during the period of September l, 2022 - Ma31, 2023.
LIABILITY RELEASE: In consideration of Shir Shalom allowing the Participant to participate in B'Yachod activities (worship, meetings, activities, and field trips) .  
I, the undersigned , do hereby release, forever
 discharge and agree tholharmlesShiShalomits clergy,directors, employees, volunteers and teachers (collectively  herein the "Temple") from any and alliabilityclaims or demands for accidental personal 
injury, sickness or death, as well a.s property damage,,..: and expenses, of any nature whatsoever which may be incurred by the undersigned and  the Participant while involved in the religious school activities.. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate: fully in religious school activities, including trips away from the temple premise,. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness death, damage and expense as a result of participation  in recreation and work activities involved thereinThe undersigned ,further hereby hold harmless and indemnify said Temple for any liability sustained by said Temple as the result of the negligent, willful or intentional acts uf said Participant, Including expenses Incurred attendant thereto.

PHOTO RELEASE: The undersigned also gives the Temple permission to use Participant's photograph or video image: on behalf of Shir Shalom including, but not limited to publicity, web content, advertising, and marketing.

I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency. x·ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any phys!clan or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all cost and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

The undersigned does also hereby give permission for my child/youth to ride in any vehicle driven by an approveand licensed  ADULT chaperone while attending and participating in activities  sponsored by Shir Shalom. My child/youth and I understand that a seat belt MUST BE WORN AT ALL TIMES during transportation.
Fri, April 19 2024 11 Nisan 5784