Permissions

I agree to waive all rights and claims against Congregation Beth Sholom and their agents and employees which may arise out of my son/daughter’s participation. I understand that my son/daughter’s participation may involve transportation in private vehicles to which I consent. I understand and agree that Teaneck Kadima/USY Youth Programs has no liability if my child travels to an event in any vehicle not provided by Teaneck Kadima/USY Youth Programs.

I certify that I understand my son/daughter’s participation in Youth programs can involve rigorous physical activity, and I further certify that my son/daughter is in good physical condition, and that my son/daughter has no medical or physical conditions that would
restrict my son/daughter’s participation.

In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parent(s) or guardian of the child. In the event they cannot be reached, I hereby give permission to a physician selected by the youth program, its employees, advisors or agents, to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia, or surgery for my child as named above. I am aware that this form may be photocopied for use by medical care givers.

I hereby grant permission for Congregation Beth Sholom to use my child’s name, likeness or
photograph in any publication, advertisement, display or other medium in connection with the programs, activities and events of Congregation Beth Sholom.