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Temple Sinai Religious School Emergency Contact & Waivers Form (2016-2017)

The following form is mandatory and must be completed before student(s) may attend school.  Only one form is required per family.








Please list the primary contact(s) you would like notified in the event of an emergency at school.

In the case of injury or illness while your child is at school, every effort will be made to contact a parent or primary contact. If there is an emergency, and we are unable to reach a parent, please give us the names of persons to be notified.

If the information is different for each student, please put the student's name next to each contact.

PARENTAL AGREEMENT AND RELEASE: In case of a medical or surgical emergency, and I cannot be contacted by telephone, I authorize the Director of Education to select a physician to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child(ren), all charges of which are to be for my account. I understand that every effort will be made to contact me immediately.

Educational Field Trip Waiver

My child(ren) has/have permission to go on educational trips sponsored by the Temple Sinai Religious School. I understand that I will be informed of all such trips ahead of time and that this form simply serves as legal permission in case the primary form is not available. I understand that students may travel by bus and/or private car and will be accompanied by staff and/or parents and that every reasonable effort will be taken to ensure my child(ren)’s well-being and safety during these supervised activities. I release Temple Sinai and its agents from all responsibilities other than those of this event. If I cannot be reached in the case of an emergency, I authorize the physician selected to care for my child(ren).

Photo Waiver

I give permission for my child(ren)’s photograph to be used for publicity in Temple Sinai’s website, newsletter or in the local press in conjunction with educational matters at any time, and without prior notification.



Internet Waiver

I give my child(ren) permission to use the Internet on computers of the Temple Sinai Religious School only as directed by school faculty and the Director of Education, for the sole purpose of educational instruction as set forth by the Temple Sinai Religious School.



Account Details

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Payment Information

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