Grade 8 Shabbaton 2024 - The Toronto Heschel School

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 December 6-7, 2024.

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
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

Grade 8 Shabbaton Forms

PERMISSION FORM

CODE OF CONDUCT

MEDICAL FORM

Land Acknowledgment