We are glad to provide free childcare for children 2.5 to 11 years old at Rosh Hashanah Evening Services and Morning Services as well as Yom Kippur Kol Nidre Services; Morning Services; and Afternoon, Memorial & Concluding Services. Space is limited and will be available by reservation only on a first come, first serve basis. For Rosh Hashanah, you must reserve by Monday, September 15. For Yom Kippur, you must reserve by Wednesday, September 24.

* Your First Name:

* Your Last Name:

* Your Email Address:

* Your Cell Phone Number:

Please use xxx-xxx-xxxx format.

* Parent / Guardian 2 First Name:

* Parent / Guardian 2 Last Name:

* Parent / Guardian 2 Cell Phone:

Please use xxx-xxx-xxxx format.

Your Home Phone Number:

Please use xxx-xxx-xxxx format.

* How many children will need childcare while you are at services?

* First Name of Child 1:

* Last Name of Child 1:

* Age of Child 1:

Special Instructions:

* We would like childcare during the following services:

Rosh Hashanah Evening Services - Mon, Sept 22 @ 8:00 PMRosh Hashanah Morning Services - Tue, Sept 23 @ 10:00 AMKol Nidre Services - Wed, Oct 1 @ 8:00 PMYom Kippur Morning Services - Thur, Oct 2 @ 10:00 AMYom Kippur Afternoon, Memorial & Concluding Services - Thur, Oct 2 @ 4:00 PM

* First Name of Child 2:

* Last Name of Child 2:

* Age of Child 2:

Special Instructions:

* We would like childcare during the following services:

* First Name of Child 3:

* Last Name of Child 3:

* Age of Child 3:

Special Instructions:

* We would like childcare during the following services:

* First Name of Child 4:

* Last Name of Child 4:

* Age of Child 4:

Special Instructions:

* We would like childcare during the following services:

TEMPLE SHIR SHALOM CHILDCARE WAIVER AND RELEASE OF CLAIMS

For and in consideration for Temple Shir Shalom’s (“Temple”) agreement: to provide temporary childcare for my minor child/children, whose name(s) is/are listed below, during Temple’s High Holiday Services, I hereby assume any and all risks and liabilities associated with my child/children’s participation, connection, or association with the Temple childcare service and release and waive any and all rights and claims that I, my child/children, heirs, executives, successors, or assigns, may now or in the future have against the Temple, its agents, employees, directors, officers, affiliates, and/or volunteers arising out of my child/children’s participation in the Temple childcare service or any related activities. I further state that my child/children is/are in proper physical and mental condition to participate in the Temple childcare service and any of its related activities, and that my child/children does/do not require any special care, treatment, attention, or other beyond the scope of normal child care.

I AM AT LEAST TWENTY-ONE (21) YEARS OF AGE, AM THE PARENT AND/OR LEGAL GUARDIAN OF THE CHILD/CHILDREN WHOSE NAME(S) IS/ARE LISTED ABOVE, AND I HAVE READ AND FULLY UNDERSTAND THE ABOVE WAIVER AND RELEASE OF ALL CLAIMS. MY SIGNATURE BELOW IS ON BEHALF OF BOTH MYSELF AND MY CHILD/CHILDREN.

* Your First Name:

* Your Last Name:

Today's Date:

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I Would Like Utilize Childcare During High Holy Day Services

TEMPLE SHIR SHALOM CHILDCARE WAIVER AND RELEASE OF CLAIMS

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