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Sinai Connections: 8th-12th Grade Program

Sunday, September 21, 2025 • 28 Elul 5785

12:45 PM - 2:45 PM

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* Name
Address
* Email
* Phone
 
This form must be completed by a parent/guardian of the child(ren). Please note every child interested in attending a Sinai Connections event, must have this registration form completed prior to the event! 

If you have any questions please feel free to reach out to our Director of Education, Zoe Levy, via email at zlevy@templesinailv.org or call the Temple Sinai office at (702) 254-5110.

We can't wait for your child(ren) to join us for a Sinai Connections event! 
Student Information
First Name
Last Name
Date of Birth
Preferred Pronouns
Participation Requirements
Agreements & Acknowledgments
(Revised April 2, 2025)
Statement on Photos & Videos

I understand Temple Sinai may take photographs and/or capture video and/or audio content including the image, likeness, or voice of me and my family, including my children, or any other information that identifies me and my family, including my children (collectively, “Content”) in connection with any and all activities related to Temple Sinai or the Mark L. Haberkorn Religious School. I authorize Temple Sinai, its assigns and transferees, to copyright, use, and publish the Content in print and/or digital publication, including social media sites. I understand and agree that any Content using the likeness of myself or family member will become property of Temple Sinai and will not be returned.

I understand that Temple Sinai may use such Content of me or my family members, with or without our names, for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web content purposes.

I hereby hold harmless and release and forever discharge Temple Sinai from all claims, demands, and causes of action that may arise by reason of this Photo/Video Release.

I am at least 18 years of age and I have read and understand the above.
Consent to Treat (Basic First Aid)

I, the undersigned, hereby authorize Temple Sinai and its designated personnel to administer basic first aid to the participant named above in the event of an injury or illness during a program/event.

I understand that this consent includes, but is not limited to, the application of bandages, antiseptics, and other basic first aid procedures as deemed necessary by the attending personnel. I acknowledge that basic first aid does not involve advanced medical care or invasive procedures.

In the case of a medical emergency, I authorize Temple Sinai to contact emergency services and provide necessary information regarding the participant’s condition and medical history.

I understand that I will be notified as soon as possible in the event of an emergency. I agree to assume all costs associated with medical treatment and transportation provided to the participant.
Release of Liability Waiver

I, the undersigned, hereby enter into this Parental/Guardian Consent Form and Release of Liability Waiver for the purpose of authorizing the named student’s participation in the enrichment activities, field trips, hands-on lab experiments, and other educational activities, which include walking, transportation by motorized vehicle, and provision of meals by staff and volunteers associated with the Mark L. Haberkorn Religious School. I acknowledge that this is a voluntary activity for which I freely give permission for my child’s participation. 
 
I further agree, in consideration of the above-named child’s participation in the enrichment activities, including all necessary preliminary and follow-up activities associated with said program, to indemnify, release, hold harmless, and discharge Mark L. Haberkorn Religious School, their officers, trustees, agents, and employees from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or relating to any loss, damage, or injury, including death, that may be sustained by the above-named child, or damage to any property belonging to said child, whether caused by the negligence of Mark L. Haberkorn Religious School or otherwise. 
 
Parent/Guardian Registration Authorization 
Parent/Guardian Digital Signature
Total $
 
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Tue, September 2 2025 9 Elul 5785