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I authorize Congregation Anshai Torah Preschool to release my child to leave Congregation Anshai Torah Preschool ONLY with the following persons. Please list name and telephone number for each. Children will only be released to a parent or guardian or to a person designated by the parent/guardian after verification of ID.
Please provide the name, address, and phone number of the responsible individual to call in case of an emergency if parents/guardian cannot be reached
In the event of an emergency which affects the health of the student, I, the undersigned, do hereby authorize officials of Congregation Anshai Torah to contact directly the persons named on this card, and if neither parent nor guardian can be contacted, I authorize the named physician to render such treatment as may be deemed necessary in an emergency, for the health of said child. In the event that neither parent nor guardian nor doctor nor any of these people can be reached, I hereby give the personnel of Congregation Anshai Torah permission to make arrangements for emergency medical attention, to transport the student to an accredited facility for diagnosis and treatment and to authorize the administration of medication as necessary.
I request and authorize physicians, dentists, and staff of the accredited medical facility to perform any diagnostic procedures, treatment procedures, operative procedures, x-ray treatments and administration of anesthetics as may be necessary in the diagnosis and treatment of above minor student. I understand that I have not been given a guarantee as to the results of examination or treatment. I agree to pay for services rendered and expenses incurred pursuant to this authorization. Further, I will not hold the Congregation Anshai Torah Officers, Directors, Administrators, Teachers, Personnel or Employees financially responsible for the emergency care and/or transportation for said child.
Does your child have any special needs we should be aware?
If yes, please list any special needs that your child may have, such as environmental allergies, food intolerances, existing illness, previous serious illness,injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of
I acknowledge receipt of Anshai Torah’s operational policies including those for:
Arrival & Release of Children, Communication, Appropriate Attire, Lunch & Snack, Parent Participation, Voicing Questions & Concerns, Health & Safety Policies, Security, Emergency Preparedness, Discipline & Guidance, Illness & Exclusion Criteria, Open Door Policy, Gang Free Zones, Texas Licensing Information and Child Abuse Hotline Information.
I acknowledge receipt of Anshai Torah’s late pick-up policies:
Child day care operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY).
All rates and totals on this page are based upon paying by cash or check. There is a 2.5% fee for credit cards that will be added to the transaction when processed. There is a 1.0% fee for e-checks that will be added to the transaction when processed. This registration process is not complete until payment arrangements are made.
