CLAL Wed/Thur Sessions

Student 1

Student First Name

Student Last Name

Hebrew Name

Birthdate

Grade in CLAL

Secular School

Madrichim (gr. 8-10, must be enrolled in CLAL High)

Yes

Madrichim (gr. 11-12)

Yes

Does this student have an IEP (Individualized Education Program)?

YesNo

Allergies/Other health issues:

Student 2 (if no additional student proceed to Family Information)

Student First Name

Student Last Name

Hebrew Name

Birthdate

Grade in CLAL

Secular School

Madrichim (gr. 8-10, must be enrolled in CLAL High)

Yes

Madrichim (gr. 11-12)

Yes

Does this student have an IEP (Individualized Education Program)?

YesNo

Allergies/Other health issues:

Student 3 (if no additional student proceed to Family Information)

Student First Name

Student Last Name

Hebrew Name

Birthdate

Grade in CLAL

Secular School

Madrichim (gr. 8-10, must be enrolled in CLAL High)

Yes

Madrichim (gr. 11-12)

Yes

Does this student have an IEP (Individualized Education Program)?

YesNo

Allergies/Other health issues:

Student 4 (if no additional student proceed to Family Information)

Student First Name

Student Last Name

Hebrew Name

Birthdate

Grade in CLAL

Secular School

Madrichim (gr. 8-10, must be enrolled in CLAL High)

Yes

Madrichim (gr. 11-12)

Yes

Does this student have an IEP (Individualized Education Program)?

YesNo

Allergies/Other health issues:

Family Information

Is your family new to CLAL?

Yes

Parent 1-First Name

Parent 1-Last Name

Religious Background

Address

City

Zip Code

Home phone

Cell phone

Parent 2-First Name

Parent 2-Last Name

Religious Background

Address

City

Zip Code

Home Phone

Cell phone

Which email should we use for school notices?

If your family is new to this school, what is the Jewish educational background of your child/children?

Does child/children reside with both parents?

YesNo

If not, with whom does student(s) reside?

If not, should both parents receive school materials?

YesNo

If not, which parent should receive school materials?

Photo Release

Do you authorize Congregation Ner Tamid to use photos of your child/children in print?

YesNo

Do you authorize Congregation Ner Tamid to use photos of your child/children in online media?

YesNo

Field Trip Permission

Do you grant permission for your child/children to participate in all activities and go on all trips arranged by CNT/CLAL/CLAL High Staff?

YesNo, I understand that my refusal to consent will disallow my student(s) from going to the park or on class trips.

Medical Information

Doctor's Name

Doctor's Phone Number

Can your child/children be administered Tylenol by the staff?

YesNo

Can your child/children be administered Benadryl by the staff?

YesNo

Can your child/children be administered Ibuprofen by the staff?

YesNo

Is there anything else that you feel is important for us to know about your child/children?

Emergency Contact Information (If the school is unable to reach either parent, you are authorized to release my child/children to the following people:)

Emergency Contact 1-Name

Emergency Contact 1-Phone

Emergency Contact 1-Relationship

Emergency Contact 2-Name

Emergency Contact 2-Phone

Emergency Contact 2-Relationship

Medical and Release Form: 2024-2025

I hereby authorize the Congregation Ner Tamid CLAL or its authorized representatives, as agent(s) for the undersigned to consent to any medical diagnosis or treatment rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the California Medicine Practice Act, as is necessary for the benefit of my child/children. The authorization is given in advance of any specific diagnosis or treatment, and is given to provide authority and power on the part of the aforementioned agent(s) to give specific consent to any such diagnosis and/or treatment which the aforementioned physician and/or surgeon in the exercise of his/her judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until the end of the current school year.

YesNo

Parent Signature

type name

Date

Upcoming Sessions

1. Wednesday, December 4, 2024 • 3 Kislev 5785

2. Thursday, December 5, 2024 • 4 Kislev 5785

3. Wednesday, December 11, 2024 • 10 Kislev 5785

4. Thursday, December 12, 2024 • 11 Kislev 5785

5. Wednesday, January 8, 2025 • 8 Tevet 5785

6. Thursday, January 9, 2025 • 9 Tevet 5785

7. Wednesday, January 15, 2025 • 15 Tevet 5785

8. Thursday, January 16, 2025 • 16 Tevet 5785

9. Wednesday, January 22, 2025 • 22 Tevet 5785

10. Thursday, January 23, 2025 • 23 Tevet 5785

11. Wednesday, January 29, 2025 • 29 Tevet 5785

12. Thursday, January 30, 2025 • 1 Shevat 5785

13. Wednesday, February 5, 2025 • 7 Shevat 5785

14. Thursday, February 6, 2025 • 8 Shevat 5785

15. Wednesday, February 12, 2025 • 14 Shevat 5785

16. Thursday, February 13, 2025 • 15 Shevat 5785

17. Wednesday, February 19, 2025 • 21 Shevat 5785

18. Thursday, February 20, 2025 • 22 Shevat 5785

19. Wednesday, February 26, 2025 • 28 Shevat 5785

20. Thursday, February 27, 2025 • 29 Shevat 5785

21. Wednesday, March 5, 2025 • 5 Adar 5785

22. Thursday, March 6, 2025 • 6 Adar 5785

23. Wednesday, March 12, 2025 • 12 Adar 5785

24. Thursday, March 13, 2025 • 13 Adar 5785

25. Wednesday, March 19, 2025 • 19 Adar 5785

26. Thursday, March 20, 2025 • 20 Adar 5785

27. Wednesday, March 26, 2025 • 26 Adar 5785

28. Thursday, March 27, 2025 • 27 Adar 5785

29. Wednesday, April 2, 2025 • 4 Nisan 5785

30. Thursday, April 3, 2025 • 5 Nisan 5785

31. Wednesday, April 23, 2025 • 25 Nisan 5785

32. Thursday, April 24, 2025 • 26 Nisan 5785

33. Wednesday, April 30, 2025 • 2 Iyyar 5785

34. Thursday, May 1, 2025 • 3 Iyyar 5785

35. Wednesday, May 7, 2025 • 9 Iyyar 5785

36. Thursday, May 8, 2025 • 10 Iyyar 5785

37. Wednesday, May 14, 2025 • 16 Iyyar 5785

38. Thursday, May 15, 2025 • 17 Iyyar 5785

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