2024 Grade 7/8 End of Year Trip - The Toronto Heschel School

Student's Full Legal Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student's Cell Phone Number(Required)

Date of Birth(Required)

Health Card Number(Required)

Parent 1 Name(Required)

First Last

Cell Phone(Required)

Work Phone

Parent 2 Name

First Last

Cell Phone

Work Phone

Emergency Contact(Required)

First Last

Relationship(Required)

Cell Phone(Required)

Work Phone

Name of Physician(Required)

First Last

Phone Number(Required)

Medical Information

List of Daily Medications (Medication must be in their original pharmacy container, bearing the name, dosage, frequency of the drug and patient's name):(Required)

Put N/A if not applicable.

Allergies (bee stings, medication, food, etc…):(Required)

Put N/A if not applicable.

DOES THE CHILD CARRY AN EPIPEN?(Required)

Yes

DOES THE CHILD CARRY A PUFFER?(Required)

Yes

Please check any of the following non-prescription/over the counter drugs that the chaperones have parental/guardian permission to administer if necessary:

Advil

Tylenol

Gravol

Benadryl

Cough Drops

Dietary Restrictions (vegetarian, sensitivities, etc…):(Required)

Put N/A if not applicable.

Since this trip involves a great deal of walking, please describe any physical problems or concerns that the chaperones should be aware of:(Required)

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)

First Last

Parent Signature(Required)

Date(Required)

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.

Signature(Required)

Date(Required)

Insurance Information

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.

Insurance Company Name(Required)

First

Insurance Company Phone Number

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Policy #(Required)

Number

Employer(Required)

Number

Employer's Phone Number:(Required)

Parent/Guardian Full Name(Required)

First Last

Signature(Required)

Passport

Code of Conduct

School dress code is in effect. Student must have a Heschel hat.

Students must always behave respectfully and courteously.

Students may bring kosher (dairy or parve) and nut-free food for the bus ride.

Wake-up time is not optional.

Students may not leave JTS or any venue/attraction without adult supervision.

No violence or aggressive behaviour is allowed. The students involved will be sent home at their parents’ expense.

Boys and girls are not allowed in each other’s rooms at any time.

No coarse language allowed.

Students must be in their rooms by 10:30 p.m., with lights out by 11:00 p.m.

Students must adhere to ‘code of conduct’ as it is outlined in the school’s Parent Handbook.

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.

2024 Grade 7/8 End of Year Trip TRIP

HEALTH & EMERGENCY MEDICAL FORM

Medical Information

Insurance Information

Passport

Code of Conduct