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SAWCY Registration
Please verify reCaptcha before submitting the form.
Student's Preferred Name
Student's date of birth
Student's Fall 2022 grade
6th
7th
8th
School
Student's cell phone number
Student's home phone number
Student's email address
Address
Address 2 (Apt., Bldg)
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--Select State--
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Parent #1 Name
Parent #2 Name
Parent #1 Preferred Phone
Parent #2 Preferred Phone
Parent #1 Secondary Phone
Parent #2 Secondary Phone
Parent #1 Email Address
Parent #2 Email Address
FOR PARENTS: Please add me/us to the RATSY Parents email list.
Yes
No
Emergency Contact #1
Please include:
NAME, RELATIONSHIP, PRIMARY and SECONDARY PHONE NUMBERS
Emergency Contact #2
Please include:
NAME, RELATIONSHIP, PRIMARY and SECONDARY PHONE NUMBERS
Allergies and Other Medical Concerns
Date of Most Recent Tetanus Booster
Doctor's Name and Office Phone Number
Insurance Carrier, Subscriber Name, and Policy Number
I hereby grant permission for my child to be a member of Sinai Association of Way Cool Youth (SAWCY) and to participate in activities. This will serve to release Temple Sinai and all of its personnel, employees, and representatives from liability in case of accident or injury resulting from all causes in connection with such membership, including outings, field trips or other activities which necessitate travel away from the Temple, except employees and representatives.
Yes
No
In granting this permission and release, I specifically recognize that my child may be transported to SAWCY events by private vehicles operated by employees, or representatives of Temple Sinai. In such regard I release and will hold harmless Temple Sinai, SAWCY, employees, agents, and representatives from any and all liability which may arise as a result of such transportation whether or not organized by SAWCY. [SELECT ALL THAT APPLY]
I grant permission to attend RATSY-sponsored events in a bus.
I grant permission to attend RATSY-sponsored events in transportation provided by an adult aged 21 or older.
I grant permission to attend RATSY-sponsored events in transportation provided by a teenaged driver.
I empower Temple Sinai of Rochester to act for me in accordance with their best judgment in case of an emergency. My child is in good physical health and does not have any conditions which may be aggravated, except as noted on the application form.
Yes
No
Tue, June 6 2023
17 Sivan 5783
Tue, June 6 2023 17 Sivan 5783