JAE Excursion Form Childs name First Name Last Name I authorise JAE staff to take my child off the grounds during JAE session on Monday May 30th 2022. I hereby authorise L’Chaim Chabad- Kingston & MHC leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I agree to the above declaration. Full Name* First Name Last Name Best contact number on the day Area Code Phone Number DATE Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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