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ELC Photography and Play Equipment Authorization Form

Temple Beth Avodah Early Learning Center
45 Puddingstone Lane
Newton, MA 02459
617-527-0045 x110

* Child's Name

* Parent Email

Photography Authorization Form

* By typing my child's name below, I give permission for my child to be photographed for publicity and/or participation in an organized fundraising activity at any time and without prior notification from Temple Beth Avodah Early Learning Center.

Play Equipment Authorization Form

* By typing my child's name below, I give permission for my child to use may use all the indoor and outdoor equipment and participate in all of the activities associated with my child’s school day, in all areas of the synagogue building. In the event that my child may not participate, I will notify the school of this change.

Signature & Date

* By typing my name below and clicking "Submit" I hereby constitute that this is my electronic signature for legal purposes.

* Date

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

ELC Photography and Play Equipment Authorization Form

Photography Authorization Form

Play Equipment Authorization Form

Signature & Date

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

ELC Photography and Play Equipment Authorization Form

Photography Authorization Form

Play Equipment Authorization Form

Signature & Date

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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