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ENROLLMENT
MEDICAL HISTORY
ENROLLMENT AND RESPONSIBILITIES AGREEMENT By signing this Enrollment Agreement I/we acknowledge and agree to the following: 1. I/We understand that my/our child/children may not attend VBS Youth programs unless I/we have paid the full amount of tuition required or have established and am/are current with an automated credit card payment plan.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 Valley Beth Shalom will enforce a behavior management policy. 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 verbal and/or sexual harassment) may result in an immediate removal from class and may result in discipline up to and including dismissal with no refund of payment. I/We have read, understand 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 Valley Beth Shalom emergency procedure, I/we, the undersigned parent(s) or legal guardian(s), do hereby release the appropriate personnel of Valley Beth Shalom to either administer first aid OR release the child/children to an emergency Hospital, urgent care facility or disaster center, for further treatment, as they deem necessary. Furthermore, I/we authorize appropriate care to be rendered by a duly licensed physician, nurse, surgeon, dentist and/or medical professional. This care may be given under whatever conditions are necessary to preserve the health and safety of the child/children. 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 personnel will try, but are not required, to communicate with me/us prior to such treatment.
** YOU MUST BE LOGGED IN TO YOUR VBS ACCOUNT FOR THE FOLLOWING 3 PAYMENT OPTIONS: 1) ACH (e-check), 2) Donor Advised Fund, 3) Payment Plan (NON-VBS Members that want to pay via ACH, must contact Camryn Kruger (ckruger@vbs.org) to set up an account.) 1) *ACH (e-check): No processing fees; can be used to pay in full, or in installments. Requires vbs.org log-in. Must be set-up as a valid payment method prior to completing this form. To set-up ACH (e-check) as a valid payment method, go to "My Account" > "My Payment Methods" > "Add New Payment Method". Follow the instructions to set-up ACH (e-check) payments through Plaid. 2) *Donor Advised Fund: No processing fees; can be used to pay in full, or in installments. Requires vbs.org log in. 3) *Payment Plans: We offer pay-in-full or monthly payment options. The monthly plan must be secured with an ACH (e-check) account, debit or credit card. Credit Card Payment Option Information: Credit Card - A 2.85% processing fee will be assessed for all credit card charges. Paying by credit card now requires members to pay the processing fee associated with the transaction(s). To eliminate this fee, please select ACH/eCheck as your payment option. If you need assistance with your payment method, please contact the VBS Accounting Office: 818-788-6000
