Parent/Guardian Information

Additional Authorized Adults

I give permission to the following adults to check-in/out my children:

Adult #1

Adult #2

Participant Information

Participant #1

Participant #2

Participant #3

Participant #4

Participant #5

I understand that by submitting this form, I agree to follow the Beth Jacob Congregation of Irvine (BJI) High Holiday Youth Program guidelines.

• All forms will be returned with the most current and accurate information no later than September 3, 2018.
• All fees will be paid.
• A parent or authorized adult must register, drop off and pickup child(ren) within the designated  times.
• A parent or authorized adult must remain on the Beth Jacob campus and be available while the child(ren) are participating in the youth program.
• Parents are responsible for confirming that their seat is correct on the seating chart, if there is a change notify staff.
• Electronic devices (including but not limited to phones, tablets, electronic games, music players, etc) are not permitted in the Youth Program.
• If a child repeatedly misbehaves (being disrespectful, going into the areas that are not allowed, or physically hurting others, etc), a parent will be notified. If the problem persists, the child will be escorted to a parent and will not be permitted to return to the Youth Program for the duration of the services.
• Parents are responsible for notifying staff of all allergies, dietary restrictions and/or medical or behavioral concerns.
• Children who are registered for the program are required to be in the space provided or with their parents in the synagogue unless parent consent has expressly been given.
• Age 2-K: if a child is crying and cannot be consoled after 5 - 10 min., the parent will be notified.
• If a child is tired, hurt or just feels like he/she needs to talk to a parent, the child will be brought to the parent or the parent will be informed of the situation.
• Snacks, a light lunch and water will be available in the classrooms for all age groups.

Participant and parent/guardian specifically assume all risks of injury arising out of his/her participation in all BJI Youth Programs during the 5779 year whether at the BJI campus or another location. I hereby waive, release and agree to hold free from all claims for damages Beth Jacob Congregation of Irvine and NCSY and its offices, directors, members, employees or agents. I will only participate in activities for which I or my child/teen are physically capable and agree not to participate in any activity that may injure myself or others.

I give permission for my child/teen to be photographed by BJI, NCSY or their representative on non-Shabbat and Holiday times. These photographs may be used in publications, including electronic publications, or in audio-visual presentations, promotional literature, advertising, or in other similar ways.