Child's Information
Please be sure to write your FULL street address and apartment number if applicable
Example: David or דוד
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad P.O.G.S. to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad P.O.G.S. personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad P.O.G.S. activities and that these pictures may be used for marketing purposes. By submitting this form I acknowledge and agree to the terms and conditions