2024 Grade 7/8 End of Year Trip TRIP

HEALTH & EMERGENCY MEDICAL FORM

 

SCHOOL/GROUP NAME: The Toronto Heschel School

NAME OF TRIP: NYC END OF YEAR TRIP

DATES:  June 17-20, 2024

Student's Full Legal Name(Required)
Address(Required)
MM slash DD slash YYYY
Parent 1 Name(Required)
Parent 2 Name
Emergency Contact(Required)
Name of Physician(Required)

Medical Information

Put N/A if not applicable.
Put N/A if not applicable.
DOES THE CHILD CARRY AN EPIPEN?(Required)
DOES THE CHILD CARRY A PUFFER?(Required)
Please check any of the following non-prescription/over the counter drugs that the chaperones have parental/guardian permission to administer if necessary:
Put N/A if not applicable.
Put N/A if no applicable.
I/we understand that the school has taken every reasonable precaution to ensure the safety and well-being of my/our child and I/we will not hold the school responsible for personal injury, loss or theft. In case of medical emergency and the inability of the school’s designate to contact me, we hereby grant permission to the physician named by the school’s authority to hospitalize, secure proper treatment for and to order injection, anesthesia, or surgery for my/our child as named below.
Name of Student(Required)
MM slash DD slash YYYY
IN CASE OF AN EMERGENCY INVOLVING THIS STUDENT AND A PARENT/GUARDIAN CANNOT BE CONTACTED, I AUTHORIZE ANY CHAPERONE ASSOCIATED WITH THIS TRIP TO OBTAIN MINOR MEDICAL CARE FOR MY CHILD.
MM slash DD slash YYYY

Insurance Information

IF THE TREATMENT IS FOR A NON-TOUR-RELATED ILLNESS OR INJURY, I AUTHORIZE THE USE OF OUR FAMILY MEDICAL INSURANCE COMPANY. INDIVIDUAL STUDENT HEALTH TRIP INSURANCE MUST BE PURCHASED BY PARENTS PRIOR TO THE TRIP.
Insurance Company Name(Required)
Billing Address(Required)
Policy #(Required)
Employer(Required)
Parent/Guardian Full Name(Required)

Passport

Canadian citizens MUST HAVE A VALID PASSPORT (valid as of June 2024 and ideally for 6 months after). If your passport requires a Visa to the U.S.A., this must be arranged at the U.S. Consulate prior to the trip. We require a photocopy of the student’s valid passport. Please upload a scanned copy below.
Max. file size: 10 MB.

Code of Conduct

  1. School dress code is in effect. Student must have a Heschel hat. 
  1. Students must always behave respectfully and courteously. 
  1. Students may bring kosher (dairy or parve) and nut-free food for the bus ride. 
  1. Wake-up time is not optional. 
  1. Students may not leave JTS or any venue/attraction without adult supervision. 
  1. No violence or aggressive behaviour is allowed. The students involved will be sent home at their parents’ expense. 
  1. Boys and girls are not allowed in each other’s rooms at any time. 
  1. No coarse language allowed. 
  1. Students must be in their rooms by 10:30 p.m., with lights out by 11:00 p.m. 
  1. Students must adhere to ‘code of conduct’ as it is outlined in the school’s Parent Handbook. 
  1. Cell phone use is restricted to the bus ride only. Cell phones will be collected during the trip and will be returned on the bus ride back home. 

My/our child agrees to conduct themselves according to the rules set out for this trip. We understand that should there be a serious infraction of these rules, the adult chaperones have the right and the responsibility to send our child home at our expense.
Parent/Guardian Name(Required)
MM slash DD slash YYYY
Student Name(Required)
MM slash DD slash YYYY