Socal Tamil Kalvi 2019 - 2020 Registration: Personal Information and Medical Release Form

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Dear parent, please fill this form each one of your children that will study in the Socal Tamil Kalvi.

SOCALTAMIL.ORG is a registered nonprofit 501 (C)(3) organization; EIN# 27-1167961. All donations are tax exempt.
socaltamilkalvi@gmail.com | www.socaltamil.org

Email *

Student's Name *

First and last name

Parent's name *

First and last name

Parent's email *

Parent's Mobile Phone number *

Which center does the student study? *

Irvine

Brea

Eastvale

Bakersfield

Santa Maria

What grade will the student study during the year 2019 - 2020? *

Preschool 1 (Mazhalai 1)

Preschool 2 (Mazhalai 2)

Basic 1

Basic 2

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Not sure

Physician Name *

Physician Phone *

Dentist Name

Dentist Phone

Emergency Contact Name *

Emergency Contact Phone *

Employer Name (Father) *

Please enter the names of the Father's empolyer. Enter "Home maker", if not working.

Employer Name (Mother) *

Please enter the names of the Mother's empolyer. Enter "Home maker", if not working.

Do you know if either of your employers match a contribution for non-profit organizations? *

Yes

Maybe

Waiver *

I agree

I decline

I give permission for my child to participate in the SocalTamil school program from Aug 2019 to May 2020.

I hereby release SocalTamil, its board of directors, representatives, agents and volunteers from any responsibility and liability for any illness or injury that my child may sustain during this activity.

IMPORTANT: *** I understand that I need to be present in the premises during every SocalTamil School program.***

In the event of an emergency, I hereby authorize an adult SocalTamil volunteer to take whatever emergency measures that are judged necessary for the care and protection of my child.

In the event of an emergency, I understand that my child will be transported by a local emergency unit for treatment, if deemed necessary by a SocalTamil volunteer.

In certain medical situations, the local emergency resource may be contacted prior to contacting the child’s parent or physician.

I hereby give Socal Tamil to use photographs and videos of me and my kids for posting on social media accounts and their website

I agree

I decline

I give permission for my child to participate in the SocalTamil school program from Aug 2019 to May 2020.

IMPORTANT: *** I understand that I need to be present in the premises during every SocalTamil School program.***

In the event of an emergency, I hereby authorize an adult SocalTamil volunteer to take whatever emergency measures that are judged necessary for the care and protection of my child.

In the event of an emergency, I understand that my child will be transported by a local emergency unit for treatment, if deemed necessary by a SocalTamil volunteer.

In certain medical situations, the local emergency resource may be contacted prior to contacting the child’s parent or physician.

I hereby give Socal Tamil to use photographs and videos of me and my kids for posting on social media accounts and their website

I hereby acknowledge that I have read and sign-off the Disclaimer and Medical Release Form electronically

I agree

I decline

Clear selection

A copy of your responses will be emailed to the address you provided.

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