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Consent and Information Form

Consent and Information Form

TDS Consent and Information Form

Information

* Denotes required field
Type N/A if not applicable
You may use one form for all students if the information is the same, be sure to put all their first names in the First Name field, separated by a comma.

Last Name of Student(s)*
First Name of Student(s)*
List Students Hebrew names and Hebrew Birthdays

Father's Occupation*
Father's Employer*
Father's Address (if different from the students)
Mother's Occupation*
Mother's Employer*
Mother's Address (if different from the students)

List any special problems that your child may have and any other infromation which TDS' employees and volunteers should be aware of. Please type the students name before listing each condition. If Not Applicable, type N/A*
Name of Medical Facilty to take your child in the event of an emergency. *
Address of Medical Facilty to take your child in the event of an emergency.*

Name and Address of one emergency contact.*

I consent for my child to be transported and supervised by TDS' employees and volunteers for emergency care on field trips, to and from home (if requested by parent), to and from school (if requested by parent). You will be notified before transportation.*
I do consent
I do not consent

I consent for my child to participate in Field Trips. (Parents will be notified of field trips date and location in advance)*
I do consent
I do not consent

I consent for my child to participate in water activities such as sprinkler play, splashing/wading pools, and water table play.*
I do consent
I do not consent

I hereby authorize that a photograph of my child may be used for publicity purposes such as The Jewish Herald Voice, TDS website, Thursday Thunder, Facebook and other media..*
I do consent
I do not consent

I give my child permission to walk to and from school*
I do consent
I do not consent

I give permission for my child to walk to and from school with an older sibling who is under the age of 18.*
I do consent. Siblings Name:
I do not consent

I have received and read the updated TDS Parent Handbook with my child/ren.

As the parent(s) or legal guardian of the above child, I/we give consent for the facility to secure any and all necessary emergency medical care for my child.

I agree to the terms and conditions above *

E-mail address of parent completing the form*Signature (name of Parent completing this form)*

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