I, the undersigned applicant, affirm the following:
A. I informed my Dr. of all my past and present illnesses, and I gave her/him all the details s/he asked of me, and I answered complete and correct answers of what was asked of me, and I informed her/him of all my past and present illnesses and hospitalizations.
B. I am aware that neither this admission form, nor my acceptance to study teaching in this institution, obligates the Department of Education and Culture to employ me upon completion of my studies, nor any time following; and that in order for me to work as a teacher, I will need to pass a health test as required by law, in addition to other criteria (pedagogical, personal, administrative, etc. factors), which will decide my ability and my acceptance to work.
C. I request to give to the Dean and teaching staff of "Beit Chana" Teachers College and/or anyone designated by the Dean in regards to this matter, all information requested by those who have permission - information regarding my medical situation, both before the signing of this disclaimer as well as the duration of time from when this was signed until the completion of my studies in the College. This includes everything - including any physical or psychological illnesses or injuries, hospitalizations, treatments, medical suggestions, and all that is related to this.
D. With my signature on this form I give explicit absolution to anyone who informs teachers about my medical situation, as mentioned above, from violating medical confidentiality for which they are bound or will be bound by law. This agreement and/or procedure and disclaimer/statement affirms that no claims will be brought against anyone who informs those who have permission for the duration of the designated time period.
E. This disclaimer and instruction stands in affect for anyone who has this form at the time of its signing or any time after during the designated time period. My medical information includes - that which is known to the Department of Health, The Department of Security (the IDF), public health service organizations (Kupot Cholim), hospitals, doctors, etc.
Full name
Email
Address
Passport number
PLEASE ANSWER THE FOLLOWING QUESTIONS:
If yes, please email all the information to seminar@beitchana.org
If yes, please email all the information to seminar@beitchana.org
If yes, please email all the information to seminar@beitchana.org.
Please note any other known pains or health issues, that you have or had:
• Please be advised that if it comes to our attention that health, behavior or learning issues/disabilities were not disclosed and later brought to our attention, we reserve the right to terminate the student's school year.
• Please be aware that Beit Chana is not able to cater to students who require special dietary meals.
• Pre-existing health issues prior to Sept. 1st, 2021 are not covered by our insurance.
• Dental care, psychological and psychiatric care, and alternative medical - visits and treatment & medications - are not covered by insurance.
• School does not pay for trips to doctors, health clinics or hospitals.
I affirm that I have read, agree, and answered all questions to the best of my knowledge.
Submit
