End of Year Trip 2025

Step 1 of 3

PERMISSION FORM

I hereby give permission for:

Student Name(Required)
First Last

to take part in the Grade 8 Shabbaton which will take place on June 10-12.

Parent Signature(Required)

Date(Required)
MM slash DD slash YYYY

CODE OF CONDUCT
Student Name(Required)
First Last
CODE OF CONDUCT
1. Students must behave respectfully and courteously at all times.
2. Students may bring kosher, nut free, parve snacks.
3. Food or drinks may not be purchased.
4. Wake up and curfew times are mandatory.
5. Cell-phone use is not permitted. Daily communication and updates will be provided by the school.
6. Violence, aggressive behaviour or bullying will not be tolerated. The students involved will be sent home at their parents’ expense.
7. Coarse language and inappropriate conversations will not be tolerated.
8. Students are not allowed in each other’s rooms at any time.
9. School dress code is in effect including Heschel kissui/Heschel hat.
10. Students must adhere to the ‘Code of Conduct’ as it is outlined in the school’s Parent Handbook.

My 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.
Student Signature(Required)
Date(Required)
MM slash DD slash YYYY

Parent Signature(Required)
Date(Required)
MM slash DD slash YYYY

MEDICAL FORM
Student's Full Legal Name(Required)
First Last
Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth(Required)
MM slash DD slash YYYY

Health Card Number(Required)

Home Phone(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)

Name of Physician(Required)
First Last
Phone(Required)

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

No
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
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.
Student Name(Required)
First Last
Parent Signature(Required)
Date(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.
Parent Signature(Required)
Date(Required)
MM slash DD slash YYYY