Midnight Run

Saturday, March 14, 2026 • 25 Adar 5786

6:00 PM - 1:00 AM Next Day

Register

Participant Information

* Participant First Name

* Participant Last Name

* Participant Email Address

Participant Cell Phone Number

Parent/Guardian Information

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

* Parent/Guardian 1 Email Address

* Parent/ Guardian 1 Cell Phone Number

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

* Parent/Guardian 2 Email Address

* Parent/ Guardian 2 Cell Phone Number

Emergency Contact Information
Emergency Contact MUST be separate from Parent/Guardian

* Emergency Contact First Name

* Emergency Contract Last Name

* Emergency Contact Cell Phone Number

* Relationship to Child

Permissions

* I, the undersigned parent of the child listed above, hereby give consent and permission for my child to participate in Midnight Run, and I empower the Trip Staff or their agents to act for me in accordance with their best judgment in case of emergency. I hereby give permission to the physician(s) selected by the staff to hospitalize, secure proper treatment, administer medication, provide anesthesia and/or perform surgery for my child as named above. I understand that all expenses for health care and medical attention will by my responsibility.

I, the undersigned parent of the child listed above, hereby give consent and permission for my child to participate in Midnight Run, and I empower the Trip Staff or their agents to act for me in accordance with their best judgment in case of emergency. I hereby give permission to the physician(s) selected by the staff to hospitalize, secure proper treatment, administer medication, provide anesthesia and/or perform surgery for my child as named above. I understand that all expenses for health care and medical attention will by my responsibility.

* I understand that Community Synagogue of Rye is not defined as an entity subject to HIPAA and therefor is not covered by HIPAA regulations concerning patient medical records. I also understand and agree that situations may necessitate that my child’s medical information be shared with the event staff. I give permission to any Health Care Provider, such as a hospital or physician, to share my child’s medical information with the event staff, for treatment purposes.

I understand that Community Synagogue of Rye is not defined as an entity subject to HIPAA and therefor is not covered by HIPAA regulations concerning patient medical records. I also understand and agree that situations may necessitate that my child’s medical information be shared with the event staff. I give permission to any Health Care Provider, such as a hospital or physician, to share my child’s medical information with the event staff, for treatment purposes.

* I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk free and so I have instructed my child on the importance of abiding by the Community Synagogue of Rye-Code of Conduct and the Community Synagogue of Rye Trip.

I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk free and so I have instructed my child on the importance of abiding by the Community Synagogue of Rye-Code of Conduct and the Community Synagogue of Rye Trip.

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Thu, February 12 2026
25 Sh'vat 5786

Thu, February 12 2026 25 Sh'vat 5786

Community Synagogue of Rye • 200 Forest Avenue Rye, NY 10580 • (914) 967-6262 • info@comsynrye.org • www.comsynrye.org

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