ENROLLMENT
MEDICAL HISTORY
ENROLLMENT AND RESPONSIBILITIES AGREEMENT By signing this Enrollment Agreement I/we acknowledge and agree to the following: 1. I/We understand that my/our child/children may not attend VBS Youth programs unless I/we have paid the full amount of tuition required or have established and am/are current with an automated credit card payment plan.Should I/ we need assistance with tuition it is my/our responsibility to contact the Valley Beth Shalom Administrative Office to set up the terms and conditions of my/our payment plan. 2. I/We understand that Valley Beth Shalom will enforce a behavior management policy. I/we understand that serious infractions such as, but not limited to, stealing, fighting, possession of contraband on campus (weapons, drugs or alcohol), willful destruction of school property, and/or bullying (including verbal and/or sexual harassment) may result in an immediate removal from class and may result in discipline up to and including dismissal with no refund of payment. I/We have read, understand and agree to be bound by this enrollment agreement for myself/ourselves and on behalf of my/our child/children.
TRANSPORTATION RELEASE I/We give permission and consent to VBS and its employees and agents to take my/our child/children on field trips as part of the normal curriculum and, to the extent possible, release Valley Beth Shalom and its employees and agents from any liability for personal injury to my/our child/children or property damage, except for injuries resulting from gross negligence of Valley Beth Shalom or their employees or agents.
MEDICAL EMERGENCY RELEASE In the event of a medical emergency, in accordance with the Valley Beth Shalom emergency procedure, I/we, the undersigned parent(s) or legal guardian(s), do hereby release the appropriate personnel of Valley Beth Shalom to either administer first aid OR release the child/children to an emergency Hospital, urgent care facility or disaster center, for further treatment, as they deem necessary. Furthermore, I/we authorize appropriate care to be rendered by a duly licensed physician, nurse, surgeon, dentist and/or medical professional. This care may be given under whatever conditions are necessary to preserve the health and safety of the child/children. I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, VBS personnel will try, but are not required, to communicate with me/us prior to such treatment.
Optional Credit Card Coverage Fee: The synagogue incurs credit card processing fees each time a member uses their credit card. Please help us cover this cost by making an optional 3% donation and it is tax-deductible. You will have an opportunity to do this before submitting your payment.
