Child Info for Events Child 1 name First Name Last Name Child 1 Grade Child Medical Conditions* Child Drug or Food Allergies Child Ongoing Medications Fathers Name First Name Last Name Father's Daytime phone Area Code Phone Number Mother's Name First Name Last Name Mother's Daytime phone Area Code Phone Number Emergency contact (other than parents) First Name Last Name Mobile Area Code Phone Number Relationship I hereby authorise L’Chaim Chabad- Kingston 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 authorise Leah Greenbaum to transport my child in her own vehicle. I agree to the above declarations. Full Name* First Name Last Name Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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