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Student Information

Select student's grade in Fall of 2025 from the dropdown below.

Medical Release

I/We, the undersigned, parent(s) of

, a minor, do hereby authorize Congregation Beth Shalom as agent for the undersigned to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable and is to be rendered under the general or specific supervision of a surgeon licensed under the provisions of the Medicine Practice Act. The authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until August 2026.

Photos for Social Media and Promotional Purposes
We often take photos of the children during activities and events.  Do you give permission for photos of your child to be featured on Congregation Beth Shalom's social media or used for promotional purposes?

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Parent Information

Parent #1

Parent #2

Emergency Contact

Please list an emergency contact if the parents cannot be reached.