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7th & 8th Grade Retreat

Friday, January 10, 2025 10 Tevet 5785

5:00 PM - 2:00 PM Next DayTemple Shir Shalom & Walled Lake Outdoor Education Center

Register


 
Please use xxx-xxx-xxxx format.

January 10-11, 2025 Madrichim Retreat 

Please complete the following information to register your child to travel to the Walled Lake Outdoor Education Center January 10-11.
 
I give my child permission to go to the Walled Lake Outdoor Education Center (WLOEC) with Temple Shir Shalom.

I understand that transportation will be provided by school bus between Temple and the (WLOEC). In case of an emergency and I am unable to be reached, I give Temple Shir Shalom the authorization to act on my behalf for the care or treatment of my son/daughter.

 
Lnadline only. Please use xxx-xxx-xxxx format.


 
Please use xxx-xxx-xxxx format.


If the second parent/guardian lives in a different household, please provide address information. If both parents reside in the same house, please leave the information blank.

 
Landline only. Please use xxx-xxx-xxxx format.

Emergency and Medical Information


 
Please list someone other than the Parents/Guardians named above.

 
Please use xxx-xxx-xxxx format.
Please use xxx-xxx-xxxx format.


 

PARENT:

1. My child has no physical or emotional problems which may be aggravated by events unless mentioned above.
2. The health history is correct as far as I know and the person herein described has my permission to engage in all planned activities, except as noted on this form.
3. In the event of a medical emergency, I give permission to the physician selected by the temple staff to secure proper treatment for my child as named above. We agree to pay any and all charges which may result from such treatment.
First and Last Name
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Tue, December 10 2024 9 Kislev 5785