Jewish Learning @ BHC 2022-2023

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Please be sure to fill out each section. Section 1 is Parent/Guardian information, Section 2 will be student information. There will be an option to add other students at the bottom of Section 2, or submit once you complete it. You will only need to fill out one form per family.

Thank you so much, we look forward to welcoming students for the 2022-2023 school year!

𝐏𝐚𝐫𝐞𝐧𝐭/𝐆𝐮𝐚𝐫𝐝𝐢𝐚𝐧 𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐈𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧

Parent/Guardian Full Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

Address *

Parent/Guardian 2 Full Name

Parent/Guardian 2 Phone Number

Parent/Guardian 2 Email

Parent/Guardian 2 Address

Photography Release: I/we hereby give consent for photographs, film, video or sound recordings to be taken of anyone in my family at Baltimore Hebrew Congregation or at a BHC sponsored activity during the 2022-2023 year. We further consent that such photographs/recordings may be used in BHC publications, promotional materials, news releases, film, video, websites or sound production as directed and approved by BHC. *

Yes

I/We give permission for BHC to use my family's contact information in the Youth Education directory. *

Yes

I/we give permission for our student(s) to attend all BHC field trips. BHC will keep parents/guardians informed of trip date, time, and location. *

Yes

I/We would be interested in being a chaperone on a trip. *

Yes

Are there any family arrangements which we should be aware? *

𝐈𝐧 𝐂𝐚𝐬𝐞 𝐨𝐟 𝐄𝐦𝐞𝐫𝐠𝐞𝐧𝐜𝐲

Doctor's Name and Phone Number *

𝐇𝐞𝐚𝐥𝐭𝐡 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐈𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧

Necessary for any treatment

Company Name *

ID Number *

Group Number *

Insured's Full Name *

BHC Emergency Authorization Form

Emergency Contact in the event we are unable to reach you *

Relationship to Student *

Cell Phone Number *

Home Phone Number *

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