Parent/Guardian Information:
Children: How Many Children are you Registering? Please Select One 1 2 3 4
Child 1 * I'm interested in:Please Select One Rosh Hashanah Kol Nidre and/or Yom Kippur Both Rosh Hashanah and Kol Nidre and/or Yom Kippur
* Is this child an infant?Please Select One Yes No If you have an infant, and they enrolled at The Jack Segal Academy, they can use their designated crib. If not, you will need to provide a pack n play.
* Are they enrolled in Jack Segal Academy?Please Select One Yes, my child is a student at the Segal Academy. No, my child is not a student at the Segal Academy. I will provide a pack-n-play. If so, they can use their designated crib. If not, you will need to provide a pack n play.
* Is your child in diapers?Please Select One Yes, my child is in Diapers. I will provide diapers and wipes. No, my child is not in diapers. If so, you will need to provide diapers and wipes (even if your child is in the school - we will not use that supply). We will make sure that the counselors are aware and checking on your child.
Is there anything you'd like for us to know about your child to help them have the best experience?
Child 2 * I'm interested in:Please Select One Rosh Hashanah Kol Nidre and/or Yom Kippur Both Rosh Hashanah and Kol Nidre and/or Yom Kippur
* Is this child an infant?Please Select One Yes No If you have an infant, and they enrolled at The Jack Segal Academy, they can use their designated crib. If not, you will need to provide a pack n play.
* Are they enrolled in Jack Segal Academy?Please Select One Yes, my child is a student at the Segal Academy. No, my child is not a student at the Segal Academy. I will provide a pack-n-play. If so, they can use their designated crib. If not, you will need to provide a pack n play.
* Is your child in diapers?Please Select One Yes, my child is in Diapers. I will provide diapers and wipes. No, my child is not in diapers. If so, you will need to provide diapers and wipes (even if your child is in the school - we will not use that supply). We will make sure that the counselors are aware and checking on your child.
Is there anything you'd like for us to know about your child to help them have the best experience?
Child 3 * I'm interested in:Please Select One Rosh Hashanah Kol Nidre and/or Yom Kippur Both Rosh Hashanah and Kol Nidre and/or Yom Kippur
* Is this child an infant?Please Select One Yes No If you have an infant, and they enrolled at The Jack Segal Academy, they can use their designated crib. If not, you will need to provide a pack n play.
* Are they enrolled in Jack Segal Academy?Please Select One Yes, my child is a student at the Segal Academy. No, my child is not a student at the Segal Academy. I will provide a pack-n-play. If so, they can use their designated crib. If not, you will need to provide a pack n play.
* Is your child in diapers?Please Select One Yes, my child is in Diapers. I will provide diapers and wipes. No, my child is not in diapers. If so, you will need to provide diapers and wipes (even if your child is in the school - we will not use that supply). We will make sure that the counselors are aware and checking on your child.
Is there anything you'd like for us to know about your child to help them have the best experience?
Child 4 * I'm interested in:Please Select One Rosh Hashanah Kol Nidre and/or Yom Kippur Both Rosh Hashanah and Kol Nidre and/or Yom Kippur
* Is this child an infant?Please Select One Yes No If you have an infant, and they enrolled at The Jack Segal Academy, they can use their designated crib. If not, you will need to provide a pack n play.
* Are they enrolled in Jack Segal Academy?Please Select One Yes, my child is a student at the Segal Academy. No, my child is not a student at the Segal Academy. I will provide a pack-n-play. If so, they can use their designated crib. If not, you will need to provide a pack n play.
* Is your child in diapers?Please Select One Yes, my child is in Diapers. I will provide diapers and wipes. No, my child is not in diapers. If so, you will need to provide diapers and wipes (even if your child is in the school - we will not use that supply). We will make sure that the counselors are aware and checking on your child.
Is there anything you'd like for us to know about your child to help them have the best experience?
* 1. Waiver and Release. I, the Participant, release and forever discharge and hold harmless Congregation Beth Yeshurun and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participation in the Activity. I understand and acknowledge that this Release discharges Congregation Beth Yeshurun from any liability or claim that I, the Participant, may have against Congregation Beth Yeshurun with respect to any bodily injury, personal injury, illness, death, or property damage that may result from my participation in the Activity. I also understand that Congregation Beth Yeshurun does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, or property damage (see insurance requirements below.) 2. Insurance. I, the Participant, understand that Congregation Beth Yeshurun does not carry or maintain and expressly disclaims responsibility for providing any health, medical, or disability insurance coverage for the Participant. EACH PARTICIPANT IS EXPECTED AND ENCOURAGED TO ARRIVE WITH MEDICAL OR HEALTH INSURANCE AND COVERAGE IN EFFECT. 3. Medical Treatment. I hereby release and forever discharge Congregation Beth Yeshurun from any claim whatsoever that arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my participation in the Activity. 4. Other. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that this Release shall be governed by and interpreted in accordance with the laws of that State. I agree that in the event that any clause or provision of the Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of the Release, which shall continue to be enforceable.
