Teen Program Registration



Teen #1 Information

e.g. 12/1/1990
Can select one above
Can select either, both, or none

Does your teen have special medical or learning needs? Food allergies?

We want your teen to be safe and have the best learning experience possible. Knowing his/her special needs will help us make that happen.

Media Release

Throughout the school year, students may be highlighted in efforts to promote CBHT Religious School activities and achievements. For example, students may be featured in materials to train teachers and/or increase public awareness of our school through newspapers, radio, TV, the web, DVDs, displays, brochures and other types of media, including social media.

As the parent or guardian, I hereby give CBHT and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media.

This is with the understanding that neither CBHT nor its representations will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for my child’s participation.

I further release and relieve CBHT, its Board of Trustees, employees and other representatives from any liabilities, known or unknown, arising out of the use of this material.

Emergency Medical Release

I hereby give my consent for Congregation Beth HaTephila staff to make available to my teen professional emergency medical care if such care is indicated. It is my understanding that a conscientious effort will be made to contact me before such action is taken. It is further understood that in the event that this is not possible, I give my permission for my teen to receive proper medical care by any doctor, nurse, paramedic or member of a medical staff of a hospital licensed in the State of North Carolina.



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