---

Mother/Guardian 1 Information

Father/Guardian 2 Information

---

*Family Information 
*We ask these questions in order to better understand and relate to each child.

---

Student Information

---

Permission, Release & Waiver of Liability:  
By completing this enrollment form and entering my digital signature below, I as the parent or legal guardian of the above child(ren) hereby release Chabad of Lakeview from any and all liability arising from claims for injuries or damages that either individually or on behalf of my child might occur during participation in Chabad Hebrew School activites.  I authorize any adult acting on behalf of Chabad of Lakeview's Hebrew School program to treat, hospitalize, or secure treatment for my child.  I further agree to pay all charges for that care and/or treatment.  It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.  I hereby give permission for my child to participate in all school activities.  I understand that my child may be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.  By electronically signing my name below, I accept these terms and conditions.