Kadima Bowling Registration

Student Enrollment Information

* Student First Name

Student Last Name

Student Birth Date

Student Email (if applicable)

Student Cell Phone (if applicable)

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Email (Parent/Guardian)

* Phone (Parent/Guardian)

* Relationship to Student (Parent/Guardian)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

REGISTER HERE

* Kadima Bowling Registration Fee- $5.00

At Congregation Beth Shalom we strive to establish an environment in which all young people may thrive. Information you provide about your child’s strengths and challenges will assist in our efforts to accommodate and provide for those needs. Any information you provide will be held in the strictest confidence and will be shared only as necessary to provide your child with a quality experience.

* Student Medical

Please Select OneNoYesDoes your child take any medications, have any illness or chronic condition that school personnel needs to be aware of (i.e., asthma, dietary restrictions, allergies, ADD/ADHD, hearing, vision, speech)?

Student Medical Details

If you answered yes on the question prior, please describe.

Please note: Congregation Beth Shalom cannot be responsible for administering any daily medications to any student. Please administer your child's medication at home, before your child comes to CBS Programming. If you child has severe allergies, please supply any needed rescue medications. Parents will receive a phone call if their child requests any over the counter pain medications.

Release Forms

By signing my name below, my child(ren) have permission to participate in the KCUSY/Kadima through Congregation Beth Shalom. I hereby authorize the Programming Director, or person designated by the Programming Director, to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the state of Kansas. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of KCUSY/Kadima.

I release Congregation Beth Shalom and United Synagogue Youth and their agents from any liability.

The possession or use of alcohol, drugs, and/or tobacco products as well as behavior that endangers the safety of my child/ren or others, will result in my child being sent home from programs. If an offense does occur, I accept responsibility for my child/ren's actions and support the staffs discipline decisions.

* Medical & Safety Release: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Media Release

From time to time your child(ren)’s photo may be taken in our classrooms or special events. We use these photos on the synagogue website, on our synagogue display boards, in the weekly Connect email, the monthly Scroll newsletter, as well as our Facebook page and other publicity materials.

* I give my permission for my child(ren)'s photo to be used:

Please Select OneOn any materialsI do NOT give my permission for my child’s image to be used

Payment Information

Total Amount

Sat, April 20 2024 12 Nisan 5784