2016-2017 Emergency Information RS Form

Wed, 08/20/2014 - 11:09pm -- bsoref

Congregation B'nai Tzedek's 

Bernice & Mannie Rabovsky Religious School 

2016-2017 Emergency Information Form

 

This online form provides the RS Office with allergy/medical/special learning information, emergency contact information, and child release information in accordance with crisis management procedures. Please indicate names of any/all persons authorized to pick up your children. Children will only be released to individuals for whom we have written permission. This online form must be completed and turned in to the school PRIOR to school starting, please make sure all required fields are filled out


For safety reasons, children will not be allowed to attend class if this form is not filled out by September 18. You will receive a confirmation email once the form is submitted to the RS office. If you have any questions, please contact Beth ([email protected]). 

Student #1 - Click to enter the information
Click to enter the information
This child uses an EpiPen Jr., EpiPen, or does not use this medication.
Please tell us what medications this student is taking.

So that we can better serve your child, please inform us of any medical / learning issues or any special accomodations your child may need.

Medical/Learning/Special Accommodations Please explain. (Please send or drop off IEP or any academic testing accommodations).
Student #2
This child uses an EpiPen Jr., EpiPen, or does not use this medication.
Please tell us what medications this student is taking.

So that we can better serve your child, please inform us of any medical / learning issues or any special accomodations your child may need.

Medical/Learning/Special Accommodations Please explain. (Please send or drop off IEP or any academic testing accommodations).
Student #3
This child uses an EpiPen Jr., EpiPen, or does not use this medication.
Please tell us what medications this student is taking.

So that we can better serve your child, please inform us of any medical / learning issues or any special accomodations your child may need.

Medical/Learning/Special Accommodations Please explain. (Please send or drop off IEP or any academic testing accommodations).
Student #4
This child uses an EpiPen Jr., EpiPen, or does not use this medication.
Please tell us what medications this student is taking.

So that we can better serve your child, please inform us of any medical / learning issues or any special accomodations your child may need.

Medical/Learning/Special Accommodations Please explain. (Please send or drop off IEP or any academic testing accommodations).