Grow Hebrew School Register - Shalom Preschool of Fort Lauderdale

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Emergency
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First NameLast Name
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I authorize all medical transportation, medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures which may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

I allow my child to be photographed and for the photos to be used in print, video and digital media.
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Payment
$1000 for the year
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Child's Information