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High Holy Days Babysitting




During the High Holy Days, we are pleased to offer babysitting services to ensure that families can fully engage in the spiritual significance of the season. 


 
Parent(s)/Guardian(s) Information
Parent/Guardian A
First Name
Last Name
Mobile Number
Email
Parent/Guardian B
First Name
Last Name
Mobile Number
Email
Participant's Information
Participant's First Name
Participant's Last Name
(i.e. bee allergy, vegetarian, prefers not to eat gluten, etc.)
Agreements & Acknowledgements
Conditions of Participation

I agree that my child(ren) will respect the Mark L. Haberkorn Religious School Brit Kavod (2025-2026). If for any reason my child(ren) does not demonstrate the behaviors in the Brit Kavod below, I understand and authorize the Director of Education and/or other Temple Sinai staff members to contact me to pick up my child(ren)the Director of Education and/or Temple Sinai staff members request that I pick up my child(ren) from the Youth Experience Program.

In addition, I agree that I (parent/guardian) will remain in the Temple Sinai building while my child(ren) are participating in the Youth Experience/Babysitting and understand that I may be contacted by either the Director of Education and/or Temple Sinai staff member and must remain reachable by cell phone.  
Brit Kavod 
2025-2026/5786
We encourage our students to internalize the message of our Brit Kavod.  Brit means “covenant” and Kavod means “respect” or “honor.” Being part of our K'hilah K'doshah, our holy community, means that we show Kavod for each other, our synagogue, and for our Religious School program.  We have every confidence that our students will live by this important community agreement. 
I will do my part by treating all students, madrichim, faculty/staff, clergy, and parents with kindness, dignity, and respect at all times by showing:
Kavod for Others: Demonstrating self-respect and respect for other people. The Mark L. Haberkorn Religious School has a zero-tolerance policy for bullying in person and or online.  Do not post photos or other materials about your fellow community members at the Mark L. Haberkorn Religious School without their specific consent. 
Kavod for Place: Demonstrating respect for our synagogue and grounds of Temple Sinai. 
Kavod for our Program: Participating, being considerate, and contributing positively toward our learning environment.
I understand that as a member of the Mark L. Haberkorn Religious School we follow a “1-2-3” disciplinary action system and as such practice the following procedures
  1. Warning: If a student acts in a way that is detrimental, they will be told they have a “1.”
  2. Warning #2 : If the behavior continues the student will be told they have a “2.”
  3. Communication: If the behavior escalates or continues the student will be told they have a “3,” be escorted to the Temple Sinai office, and given an independent study assignment to complete under the supervision of a member of the Mark L. Haberkorn Religious School staff. At this time, the student’s parent/guardian will be contacted to pick up their child. The Director of Education will communicate with all families involved.  
I understand that some incidents may require immediate direct involvement with parents/guardians and the Director of Education. In addition, I understand a student may automatically receive a “3” for a specific action.  Finally, I acknowledge that repeated disciplinary issues may result in the separation of your child from the Mark L. Haberkorn Religious School.
 
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. 
 

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.
Signature & Confirmation
By checking this box, I authorize the usage of my electronic signature
Fri, July 4 2025 8 Tammuz 5785