Please verify reCaptcha before submitting the form.
This health history is correct as far as I know. The person(s) herein described has my permission to engage in all prescribed activities except as noted above. I release Ohabei Shalom and its staff from all responsibilities other than classes, programs, and supervised and scheduled activities. In the event that I cannot be reached in an emergency, I hereby authorize the physician selected by the Ohabei Shalom Religious School Directors to hospitalize, secure proper treatment for and order injections, anesthesia, or surgery for my child named above.
The Ansin Religious School of Temple Ohabei Shalom may use any individual or group photographs, written comments, video and/or audio recordings, taken at Temple Ohabei Shalom or elsewhere, documenting student in-school or out of school activities, for the purpose of promoting student enrollment and/or advertising the school, including, without limitation, on the Temple Ohabei Shalom website. TOS Staff is aware of the legal, moral, and ethical issues surrounding images of students in the public domain and will comply with all necessary guidelines.
My student(s) has my permission to participate in field trips and youth group events planned by the Ansin Religious School of Ohabei Shalom during the 2023-2024 academic year. I understand that all trips will be adequately supervised and that transportation will either be by parental carpools, school buses, the MBTA or walking and that I will be informed beforehand of all such trips.