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CAMP JACOBSON BIRTHDAY PARTY WAIVER FORM

RELEASE OF LIABILITY

 

I understand that Sid Jacobson Jewish Community Center is making its Camp Jacobson facility (340 Wheatley Road, Old Westbury, NY) available for my child to participate in the birthday party hosted here during the specified time. When I am present, it is my primary responsibility to accompany my child and make sure he or she is safe and is acting in a way to keep other children, parents, and guardians safe. My child is in good health and able to participate safely.

In consideration of being allowed to participate in any way in the birthday party and its related activities, I, the undersigned, acknowledge, appreciate and agree that:

There is a risk of injury from physical activities, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

While best efforts will be used to keep participants safe from the COVID-19 virus, I understand that there can be no promise or guarantee that this or any other pathogen will not enter the premises, and that by the very nature of the personal interaction that takes place in social environments, there is always a risk of my becoming ill with this or any other communicable disease. I am fully aware of this risk in making the decision to attend this function, and I am willing to assume and accept it; and,

I KNOWINGLY AND FREELY ASSUME ALL OF THE ABOVE SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

I willingly agree to comply with any and all stated and customary terms and conditions for participation.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the staff at the function immediately; and,

I, for myself and behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, Sid Jacobson Jewish Community Center, its officers, officials, agents and/or employees, board members, other participants, sponsoring agencies, sponsors, advertisers, and if, applicable, owners and lessors of the premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY AND DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 

I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the function with the applicable staff members. 

Sid Jacobson Jewish Community Center has the right to publish photos or videos from classes, parties or events.  In addition, Sid Jacobson Jewish Community Center is not responsible for lost or stolen property.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEEMENT, FULLY UNDERSTAND THE TERMS, UNDERTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

By signing below, I have read and agree to the legal agreement above.

                        

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do content and agree to his/her release as provided above of all Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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