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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Email *
Child's name *
Primary Care Doctor's Name *
Primary Care Doctor's Phone Number *
Medical Insurance Company *
Medical Insurance Policy # *
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