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Signature Packet

  • Signature Packet 2020-2021

  • This digital forms on this page include important information regarding health and safety for your children. Every family must complete these forms prior to AUGUST 12th, 2020 , for their student to begin the new school year.  

    FYI: Neither OTC or prescription medicine will be disseminated without required signatures in the Medication and Health Related Materials sections below.  


    I (we) the undersigned parent(s) or legal guardian(s) of the minor children listed above, do hereby authorize and consent for any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provision of the Medical Practice Act or a dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital holding a current license to operate a hospital from the State o California Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power to tender care which the aforementioned physician in the exercise of his best judgement may deem advisable. It is understood that efforts shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if he undersigned cannot be reached. This release only gives HEBREW ACADEMY and agents thereof, the right to consent to treatment of of minors. It does not release signee of liability from medical costs arising from said treatment. HEBREW ACADEMY does not assume responsibility of said cost and is not liable for any complications arising from said treatment.   



    Neither OTC, or prescription medicine will be disseminated without required signatures.

    For the safety of your child, we employ strict policies regarding the dispensing of all medications at school. "Medication" may include, but is not limited to over-the-counter remedies (such as aspirin, tylenol, and cough syrup), nutritional supplements, herbal remedies, topical creams, andanysubstance dispensed by prescription.  Please review the following information so that any use of medication by your child at school complies with school policy. Parents are required to review the medical and health policies in the Parent Student Handbook.

    Physician Instructions and Parent Request

    BOTH the Physician Instructions Form (to be completed my a physician) AND the information below must be completed before any medication(prescription)can be given, or taken, at school.

    Signatures of both physician and parent/guardian are required. This form must be renewed annually or with any change in medication.

    I/we hereby request that the staff of the Hebrew Academy of Huntington Beach assist with giving medication(s) to my/our child listed below as stated in the accompanying physician instructions.I/we also give permission to contact the physician for consultation and exchange of information as needed.  

    Release of Liability and Agreement to Indemnify and Hold School Harmless (must be completed)

    I/we hereby expressly release, hold harmless, and agree to indemnify and defend the Hebrew Academy of Huntington Beach and its Governing Board members, officers, employees, agents, representatives, independent contractors and insurers (collectively referred to as the "School") from all claims and liability for any personal injuries, death, or property damage that may be incurred by permitting the school to assist in the giving my child’s medication. This release, hold harmless and indemnification agreement shall remain in effect until the written notice to terminate the agreement is received and acknowledged in writing by the school principal.  I/we understand and agree that if I/we terminate this agreement, the school will no longer assist in giving medication to my child.  

    I/we understand that school regulations require student medication to be maintained in a secure place, under the direction of an adult employee of the school and not carried on the person of a student.(Some emergency medications may be self-carried with written physician instructions and compliance with school policies. See accompanying information on self-carrying of medications.)

    I/ we give the school permission to contact my/our child’s physician and inform school personnel regarding possible side effects of the drug on my/our child’s physical, intellectual, and social behavior as well as signs and symptoms of side effects, omission, or overdose.

    All medication orders will be automaticallydiscontinuedat the end of the school year. New orders are required each school year.

    California Education Code section 49423provides that any pupil who is required to take, during the regular school day, medication prescribed for him by a physician, may be assisted by the school nurse or other designated school personnel if the school district receives (1) a written statement from such physician detailing the method, amount, and time schedules by which such medication is to be taken and (2) a written statement from the parent or guardian of the pupil indicating the desire that the school district assist the pupil in the matters set forth in the physician's statement.

  • Student Work and Photo Release 

    The Hebrew Academy promotes the positive activities, honors, and work of our staff and students. This includes working with the local newspapers, radio and television stations, and developing our own publications. These publications include school work, likenesses, and images, which may appear on the school website as well as in other publications.

    There will be opportunities for students to have their work and/or photo published. Students will be identified by first name and grade level only. However, we understand that some parents may request that we do not identify their child(ren). Please initial the sign-off sheet to give us permission to release your child(ren)’s work and/or photos. Your child(ren)’s image or likeness may appear in occasional candid photos without any type of name identification and the use of these candid photos of your child(ren) is permissible. This photo release form does not apply to photographs taken during extracurricular activities. Students who attend extracurricular activities forfeit their rights to retain authority over the publication of photos taken.

  • Intergenerational Outreach Program

    Grandparents and other older adults are very special people in children’s lives.  Our students will be sending Holiday Greeting Cards to grandparents. Please submit the names and addresses of two grandparents or seniors in your community to whom you would like your child/ren to send their holiday cards. 

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