TBT Religious School Medical Release Form

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TBT Religious School Medical Release Form

MEDICAL AND INSURANCE INFORMATION

Please complete and submit this form by Wednesday, 8/17/22. The first day of school is Sunday, 8/21/22.

Please complete this section in its entirety once for EACH child you are enrolling. For questions or concerns, please contact Mara Sheade at admin@bethtorah-fremont.org or (510) 656-7141.

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* Required

Email *

Your email

Child's name *

Your answer

Primary Care Doctor's Name *

Your answer

Primary Care Doctor's Phone Number *

Your answer

Medical Insurance Company *

Your answer

Medical Insurance Policy # *

Your answer

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