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CSI Youth Groups Application Form

STUDENT INFORMATION

PARENT 1 INFORMATION
PARENT 2 INFORMATION

Medical Information
**In addition to filling out information below, please submit a copy of your insurance card to Nancy Gorod, Director of Congregational Learning (ngorod@shearithisrael.com/404.503.9906).

ADDITIONAL INFORMATION

PAYMENT

FIELD TRIP RELEASE FORM

I hereby grant my child, named above, to participate in all field trips with Congregation Shearith Israel Youth Department for the 2018-2019 school year.

I hereby hold and release Congregation Shearith Israel, and/or its representatives and/or agents from any liability regarding thereto, including, but not limited to, transportation to and from all activities relating to the field trip, except to the extent of insurance availability.

PHOTO RELEASE

CSI has a Youth group website and a Facebook page where photos and videos from Youth group events are periodically published. We also have a Youth group bulletin board where we sometimes post photos from events. It is CSI's policy that photos of children are never published with names or other identifying information. Please initial one:
Wed, June 19 2019 16 Sivan 5779