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ECLC Student Health Form 2024-2025



Thank you for enrolling in the VBS Etz Chaim Learning Center (ECLC) Hebrew School! This form is for families who have already paid their VBS membership and ECLC registration. If you have not yet renewed your VBS membership, please visit vbs.org/eclcrenew to complete the process. 


Student 1 Information
Does your child have a 504 or IEP in place at their secular school?
If yes, please provide additional details so we can better support your child's success in our school.

Student 2 Information
Students may request up to 3 classmates. Only ONE classmate is guaranteed.

Student 3 Information
Students may request up to 3 classmates. Only ONE classmate is guaranteed.

Student 4 Information
Students may request up to 3 classmates. Only ONE classmate is guaranteed.





ENROLLMENT AND RESPONSIBILITY AGREEMENT

By typing below, I am acknowledging and agreeing to the following:

1. I/We understand that my/our child/children may not attend VBS Etz Chaim Learning Center unless I am a/we are member(s) in good standing of Valley Beth Shalom and that I/we have paid the full amount of the non-refundable tuition required for my/our child/children grade level(s). Should I/we need assistance with tuition it is my/our responsibility to contact the Valley Beth Shalom Administrative Office to set up the terms and conditions of my/our payment plan.

2. I/We understand that the Etz Chaim Learning Center will enforce a behavior management policy, and that all students are required to adhere to school and classroom policies as stipulated in the Etz Chaim Learning Center responsibility agreement in the parent/student guide. I/We understand that serious infractions such as, but not limited to, stealing, fighting, possession of contraband on campus (weapons, drugs or alcohol), willful destruction of school property, and/ or bullying (including sexual harassment) will result in an immediate removal from class and dismissal with no refund of tuition.

3. The Etz Chaim Learning Center makes no representations or guarantee as to any particular educational or social outcomes for my/our child/children. I understand that VBS may change its course offerings and activities, as well as its policies, procedures and practices, from time to time as circumstances may warrant, in its sole discretion.  

4. Delinquency of payments due under this Enrollment Agreement may, at VBS' sole discretion, result in the suspension or dismissal of my/our child/children, from the Etz Chaim Learning Center.

5.  I/We understand that the duties and obligations of the Etz Chaim Learning Center under this Agreement may be suspended immediately without notice during all periods that the it is closed or otherwise unable to perform its obligations under this Agreement because of force majeure events. A force majeure event shall mean any cause beyond the School’s control that prevents, delays, or otherwise interferes with the School’s performance of its obligations under this Agreement, and by way of example only, includes, but is not limited to fire, earthquake, flood, storm, accident, extreme weather events, acts of God, war, governmental action, terrorism, epidemic, pandemic, strike, or work stoppage. If such an event occurs, the School shall have no liability nor shall it be deemed to be in breach of this Agreement for any delay or failure to perform its duties and obligations in this Agreement, which may be suspended or postponed, at the sole discretion of the School. The School may also alter its calendar, provide alternate means of instruction, or take any other action it deems appropriate under the circumstances. In the event the School is unable to perform its obligations under this Agreement, or such performance is delayed or interfered with as a result of a force majeure, the School shall  not be liable for any damage, remedy, or tuition refund. A closure or suspension of services due to a force majeure event shall not relieve me of any obligation, including, without limitation, payment obligations pursuant to this Agreement. 

I/We have read, understood and agree to be bound by this enrollment agreement for myself/ourselves and on behalf of my/our child/children.
MEDICAL EMERGENCY RELEASE

In the event of a medical emergency, in accordance with the VBS Etz Chaim Learning Center’s emergency procedure, I/we, the undersigned parent(s)/legal guardians, do hereby release the appropriate personnel of Valley Beth Shalom to either administer first aid OR release the child/children to an emergency hospital or disaster center, for further treatment, as they deem necessary. Furthermore, I/we authorize appropriate personnel of Valley Beth Shalom acting on behalf of VBS Etz Chaim Learning Center, to consent to all emergency medical care for this child/children to be rendered by a duly licensed physician, surgeon, dentist and/or other medical professional. This care may be given under whatever conditions are necessary to preserve the health and safety of the child. I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, VBS Etz Chaim Learning Center personnel will try, but are not required, to communicate with me/us prior to.
PICK UP RELEASE

In accordance with the VBS Etz Chaim Learning Center’s emergency procedures, I authorize the release of my child/ children to the following (list below contacts that are located within close proximity to the school):
PHOTO/AUDIO/WEBSITE RELEASE

I give permission for photographs, slides, video or audio to be taken of my child/children to be used for the VBS Etz Chaim Learning Center calendar, website, public relations and promotional purposes. I understand that none of the above may be used by the mass media for newspaper or television stories without my consent for usage.

FIELD TRIP RELEASE

I give permission and consent to VBS Etz Chaim Learning Center and its employees and agents to take my child/children on field trips as part of the normal curriculum and, to the extent possible, absolve VBS Etz Chaim Learning Center and Valley Beth Shalom and its employees and agents from any liability for personal injury to my child or property damage, except for injuries resulting from gross negligence of VBS Etz Chaim Learning Center, Valley Beth Shalom or their employees or agents.
I understand that for all field trips that require transportation, I will receive a permission slip. Unless I have signed the permission slip my child will not be permitted to go on the trip.
Fri, December 27 2024 26 Kislev 5785