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Jr. Kadima Membership Form & Waiver 2019-2020

Membership in Jr. Kadima entitles you to receive discounts for every event. Cost is $12 payable to Park Synagogue. Please return this form with dues to Rabbi Marcus at Park Synagogue, 27500 Shaker Blvd, Pepper Pike, OH 44124
 or fill out and pay online at parksynagogue.org

if applicable


I agree to notify The Park Synagogue Youth Groups if at any time the above information is changed or incorrect. The Park Synagogue is entitled to rely on the above information and any additional information about my child of which I inform you in writing. I and my child clearly understand that no smoking or drugs, other than those prescribed by a licensed physician will be permitted on any trip. I and my child also understand that, in the event of behavior unacceptable to The Park Synagogue agents or employees, you will send my child home at my expense after making a reasonable attempt to notify me.

Note: This trip waiver covers all trips during the school year. You will be notified, in advance, about each trip, which will state destination, departure and return times, and method of transportation.


I/We [Parent(s) Name(s)] hereby grant permission to [Hospital Name] Hospital and the emergency room physician to administer any emergency treatment deemed necessary. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

[Emergency Contact] (person to contact if unable to reach parents) has the authority to give additional instructions and consent if parent cannot be reached.

Child's Medical History

Account Details

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Payment Information

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