High Holiday babysitting - Skokie Valley Agudath Jacob Synagogue

HIGH HOLY DAY BABYSITTING REGISTRATION 5783/2022

This form is for children ages 2 and under participating in High Holy Day babysitting.

Please fill in the information requested below. (You must agree to the release for your children to participate in scheduled programming. You will find this in the last section of this form.)

We do provide snacks, so please make sure to fill out the allergy information as thoroughly as possible. Please note that parents are expected to change their child’s diapers, staff will find you in services if needed.

Shanah tovah!

* Parent First Name

* Parent Last Name

* Parent Email

* Parent Phone

Parent First Name

Parent Last Name

Parent Email

Parent Phone

Family Emergency Contact Name

Family Contact Emergency Phone Number

Parents will be attending the following services (check all that apply):

Skokie Valley SanctuarySkokie Valley Social HallSkokie Valley TentKol Sasson

* How many children 2 and under will attend babysitting?

* Child 1 Name

* Child will attend (check all that apply)

Rosh Hashanah Day 1Rosh Hashanah Day 2Yom Kippur Day

* Birthdate

Hebrew birthday

* Does your child have any allergies? If none, please write N/A.

Anything else you want us to know about your child?

* Child 2 Name

* Child will attend (check all that apply)

Rosh Hashanah Day 1Rosh Hashanah Day 2Yom Kippur Day

* Birthdate

Hebrew birthday

Does your child have any allergies? If none, please write N/A.

Anything else you want us to know about your child?

* Child 3 Name

* Child will attend (check all that apply)

Rosh Hashanah Day 1Rosh Hashanah Day 2Yom Kippur Day

* Birthdate

Hebrew birthday

Does your child have any allergies? If none, please write N/A.

Is there anything else you want us to know about your child?

* Child 4 Name

* Child will attend (check all that apply)

Rosh Hashanah Day 1Rosh Hashanah Day 2Yom Kippur Day

* Birthdate

Hebrew birthday

Does your child have any allergies? If none, please write N/A.

Is there anything else you want us to know about your child?

Enter an amount

Sponsorships are appreciated to help defray costs

Total Amount Due

Release & Behavior Expectations (required for participation)

Please read and agree to the release below.

I give my children listed above permission to attend all programming sponsored by Skokie Valley Agudath Jacob Synagogue and Kol Sasson Congregation for the 2022 High Holy Days. While I understand that the Skokie Valley & Kol Sasson Youth Department strives to maintain a safe environment for its participants, I also understand that there are inherent risks in some of the activities with which my child may be involved. Accordingly, I, on behalf of myself and my minor child, agree that the Skokie Valley & Kol Sasson shall not be legally responsible for my child’s personal health, or any injury of any kind. I hereby release the Skokie Valley & Kol Sasson, its partnering agencies, volunteer locations and the staff of any of these organizations from any liability to me, any member of my family, or my property arising from or in connection with Skokie Valley & Kol Sasson youth programs or activities. In the event of an emergency, I give permission to Skokie Valley & Kol Sasson to facilitate proper medical care as it deems reasonably necessary while efforts are made to reach me. In the event there is a claim against Skokie Valley & Kol Sasson as a result of any conduct of my child, I agree to indemnify and hold Skokie Valley & Kol Sasson harmless from such claim even if such claim is alleged to arise in whole or in part from the negligence of Skokie Valley & Kol Sasson or any of its agents, staff, or employees.

Please electronically sign your name below

* Signature