I/We hereby authorize Midrasha staff as agent for the undersigned to consent to any X-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California.
This authorization shall remain in effect until June 30, 2020.
PARENT/GUARDIAN UNDERSTANDING: PERMISSION
1) I authorize my child to leave the Midrasha site for supervised field trips. I give my permission to Midrasha to use this emergency information for all classes, events, and retreats attended by my child. In the event that this information changes or that I will be out of town, I will provide the Midrasha Director with updated emergency contact information.
2) I have instructed my child to abide by all rules of safe and respectful conduct during Midrasha class and retreat activities. I understand that failure to follow safety rules will result in my child being sent home at my expense and being excluded from future activities and I will still be liable for any unpaid tuition.
3) At their discretion, the Midrasha Director may remove my child from any program or retreat for reasons related to health or violations of Midrasha policies and Code of Conduct. Upon request, I agree to arrange for my child to be picked up from any retreat or Midrasha program immediately.
4) Neither I nor any other representative of ours will sue, claim against, attack the property of, or prosecute any of Midrasha, its directors, officers, agents and employees, and all affiliated entities for loss of property, injury, harm, accident, illness, loss of limb or life, or other personal injury, incapacity, medical cost, expense, damage, claim, or liability, howsoever caused, and regardless of whether caused directly or indirectly by my child’s acts or any acts arising out of or in connection with their participation in Midrasha and/or the retreat program, or any activity associated with either program.
5) I understand that if the online RSVP is not received by the published deadline, my child may not be able to attend the retreat, regardless of payment received or invoiced.
6) I grant permission for the use of still and moving photos of the above named minor in Midrasha promotional materials, unless otherwise indicated in writing.