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Register 5780

  • Child's Info

  • Parent's Info

  • Emergency Information & Terms

  • In the rare case that there is an emergency and we cannot reach either parent, please let us know who we can contact.

  • Agreement

  • As parent(s) or legal guardian, I/we authorize all medical transportation, medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures which may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. I further agree to pay all charges for that care and/or treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

    I allow my child to be photographed and for the photos to be used in print, video and digital media.

    I hereby give permission for my child to attend all field trips and outings sponsored by CKids GROW Club

  • Amount to Charge

  • $0.00
    Credit Card
    Check can be made payable and mailed to Chabad of Rancho Mirage • 72-295 Via Marta • Rancho Mirage, CA 92270
    Billing Address
  • Should be Empty:
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