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Congregation Kol Ami Religious School Registration 2022-2023

I give my permission to the following persons to pick-up my child/ren from Congregation Kol Ami:

The Following Person/People are NOT authorized to pick up my child/ren:

Please make sure to complete ALL the information requested for each child.

Child #1

Confidential Educational Information:

Child #2

Confidential Educational Information:

Confidential Medical Information:

Child #3

Confidential Educational Information:

Confidential Medical Information:

Parental Agreement and Release

I approve of the above information and registration for my child/ren. I understand that the Director of Congregational Learning or another member of the Temple staff will contact me in case of an emergency. If I am going to be out of town, I will provide information as to how I can be reached in case of an emergency. I hereby grant to the Director to hospitalize, secure proper treatment, order injection, anethsesia or surgery for my child as a result of the foregoing.

Account Details

Enter your name and e-mail address for your confirmation

Payment Information

  

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