2nd Graders Registration to SHEVET OFEK Introduction Day

משפחות יקרות שלום,

ברוכים הבאים לשבט אופק!

אנו שמחים לפתוח את ההרשמה לפעולת ההיכרות שלנו שתיערך כמיטב המסורת ביום ראשון, 7 במאי 2023.

מי: הפעולה מיועדת לכל הילדים דוברי העברית בקהילה העולים לכתה ג' בשנה הבאה ומעוניינים להצטרף לצופים.

מתי: הפעולה תיערך ביום ראשון, 7 במאי 2023, משעה 3:30 עד 5:00.

איפה: הפעולה תיערך בפארק בניוטון. כתובת מדוייקת תישלח לנרשמים.

מדובר בפארק מקסים ורחב ידיים, עם מדשאה גדולה, מגרשי ספורט וגן שעשועים.

מה עוד: את הפעולה יעבירו מדריכים בוגרים בשבט. אתם מוזמנים להישאר ולחכות במקום, או להוריד את הילדים ולחזור לאסוף אותם בסוף הפעילות.

ההרשמה ללא תשלום, אך חובה להירשם מטעמי ביטוח, וילד שלא יירשם בטופס זה לא יוכל להיכנס לפעילות.

מצפים לראותכם!

לכל שאלה או בעיה אנא צרו קשר במייל: admin@shevetofek.org

או בוואטסאפ ליפעת: 339-223-5494

Participant Information

First Name *

Last Name *

Gender *

Grade *

Birth Date * +

Medical Allergies *

Child does not have any Medical Allergies

My child has an allergy

Please specify what type of allergy: *

Any Medical Conditions or Concerns

Medications *

My child does not take any medications

My child is taking the following medications:

Please specify which medication and treatments *

Is there anything you'd like to tell us about your child? (e.g. behavioral challenges, school IEP, etc) This information can help us better support your child during the year. Alternatively - please feel free to reach out to the Scouts Leadership to privately discuss issues or concerns.

Second Child

First Name *

Last Name *

Gender *

Grade *

Birth Date * +

Medical Allergies *

Child does not have any Medical Allergies

My child has an allergy

Please specify what type of allergy: *

Any Medical Conditions or Concerns

Medications *

My child does not take any medications

My child is taking the following medications:

Please specify which medication and treatments *

Is there anything you'd like to tell us about your child? (e.g. behavioral challenges, school IEP, etc) This information can help us better support your child during the year. Alternatively - please feel free to reach out to the Scouts Leadership to privately discuss issues or concerns.

Third Child

First Name *

Last Name *

Gender *

Grade *

Birth Date * +

Medical Allergies *

Child does not have any Medical Allergies

My child has an allergy

Please specify what type of allergy: *

Any Medical Conditions or Concerns

Medications *

My child does not take any medications

My child is taking the following medications:

Please specify which medication and treatments *

Is there anything you'd like to tell us about your child? (e.g. behavioral challenges, school IEP, etc) This information can help us better support your child during the year. Alternatively - please feel free to reach out to the Scouts Leadership to privately discuss issues or concerns.

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Email Address *

Parent 1 Cell Phone *

Parent 1 Cell Phone for WhatsApp communication (If different from the local number)

Parent 2 First Name *

Parent 2 Last Name *

Parent 2 Email Address *

Parent 2 Cell Phone *

Parent 2 Cell Phone for WhatsApp communication (If different from the local number)

Address *

City *

State *

Zip *

Health Insurance Company *

Health Insurance Policy number *

CONSENT, RELEASE AND INDEMNIFICATION

The Parent/guardian signing below (“Parent”) hereby consents and gives permission for Parent’s son/daughter (“Child”) to participate in Tzofim Shevet Ofek Introduction Day (the “Event” which term shall include all activities and times during the Event, arrival at and departure from the Event, and early dismissal or expulsion, if any, from the Event) on or about the following date(s) May 7, 2023 and any date(s) to which such Event may be postponed.

In case of medical emergency involving Child, if Parent or another parent or guardian of Child cannot be reached, Parent hereby consents and gives permission to the physician selected by the Event Director to secure necessary and appropriate treatment for Child including hospitalization, anesthesia, surgery and any other emergency treatments deemed necessary by the physician. Parent agrees that Friends of Israel Scouts (“FOIS”) is not responsible for any medical expenses incurred by or on behalf of Child, represents that the parent has medical insurance coverage covering the Child’s potential medical expenses, and authorizes FOIS to directly contact and deal with any health insurance company that may provide coverage for Child.

Parent and Child each understand and agree that the Event may include activities involving risk to Child. Parent and Child each represent that Child is in sound physical, mental and emotional health and fully able to participate in all Event activities without need of individualized or specialized attention, accommodation or medical regimen.

Parent and Child each agree that FOIS has the right, in its sole discretion, to determine that Child may not participate in the Event or particular Event activities and, further, in its sole discretion, to determine that Child shall be dismissed or expelled from the Event.

Parent and Child each agree that FOIS may use any photograph, image, likeness, statement or utterance of Child or Parent in any media, including the internet, for promotional or other purposes.

In consideration for Child’s acceptance to participate in the Event, Parent and Child (and Parent on behalf of child), each for themselves, and their heirs, representatives, and next of kin, hereby forever release, waive, discharge and covenant not to sue, and agree to indemnify, defend and hold harmless FOIS and each of their (individually or collectively) affiliates, related entities, officers, directors, employees, volunteers, members, agents and representatives (individually and collectively, “FOIS”) from and with respect to any and all claims, demands, actions, rights of action, and liability, damage, cost, loss and expense (including attorneys’ fees) of any kind whatsoever, past, present and future, both known and unknown, including those which have not yet arisen or matured, either in law or in equity, arising from, related to or in connection with Child’s participation in the Event.

Parent and Child each agree that this and any other agreement related to the Event, and all disputes, issues and matters arising from, related to or in connection with the Event, are to be governed by the laws of the State, without giving effect to principles of conflicts of laws. Parent and Child each hereby consent to the exercise of personal jurisdiction over each of Parent and Child by the courts of the State and the federal court in connection with any matter arising from, related to or in connection with the Event, or this and any other agreement related thereto, and Parent and Child each further agree that such courts shall have exclusive jurisdiction over all such matters. If any term or provision hereof is determined to be invalid by a court of competent jurisdiction, the remaining terms and provisions shall remain unimpaired and in full force and effect.

In the event of a medical emergency, I hereby grant permission to the physician selected by FOIS or authorized representative to secure medical treatment for my child, which treatment may include, but is not limited to, hospitalization, dispensing of medication and/or surgery, as may be deemed appropriate by the physician who is consulted.

I also permit authorized representatives of FOIS to dispense to my child over-the-counter medications (Tylenol, Advil, Midol, cold/cough preparations, Band-Aids, etc.) or emergency medications (Such as Epipen, Asthma Inhaler, etc...) when necessary. I will provide any special instructions or medical issues regarding the dispensing of these types of medications to my child on the registration form.

As part of the FOIS Medical Authorization, I have provided FOIS (above) with a list of any medical conditions and/or allergies which pertain to my child.

Parent and Child each have read, understand and agree to the above terms and conditions.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health
Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person
contact. As a result, federal, state, and local governments and federal and state health agencies
recommend social distancing and have, in many locations, prohibited the congregation of groups of
people. Friends of Israel Scouts (Tzofim) and the Shvatim have put in place preventative measures to
reduce the spread of COVID-19; however, The Tzofim and the Shvatim cannot guarantee that you or your
child(ren) will not become infected with COVID-19. Further, participation in the Tzofim and the Shvatim
meetings and activities could increase your risk of contracting COVID-19.

READ CAREFULLY BEFORE SIGNING

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the
risk that I may be exposed to or infected by COVID-19 by participation; and that such exposure or infection
may result in personal injury, illness, permanent disability, and death. I understand that there is a risk of
becoming exposed to or infected by COVID-19 at The Tzofim and Shvatim meetings and activities.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself
or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss,
claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation
The Tzofim and the Shvatim meetings and activities. On my behalf, I hereby release, covenant not to sue,
discharge, and hold harmless the Tzofim and the Shvatim, their employees, volunteers, and
representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or
expenses of any kind arising out of or relating thereto. I understand and agree that this release includes
any Claims based on the actions, omissions, or negligence the Tzofim and the Shvatim, their employees,
volunteers, and representatives; and the meetings/activities/programs' site/host/venue, including its employees, volunteers, and representatives, whether a COVID-19 infection occurs before, during, or after
participation at The Tzofim meeting and activities.

By signing this document, I agree that if I am exposed or infected by COVID-19 during my participation in
the Tzofim meetings and activities, then I may be found by a court of law to have waived my right to
maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I agree that, to the best of their ability, my child will follow all Tzofim and Shvatim safety guidelines and
will attempt to practice safe social distancing and clean hygiene at all times during their participation.

*

I have read the Information above and agree to it

*

I authorize my child to participate in Shevet Ofek Introduction Day 2023

Please print FULL NAME: *

Email *

Date * +

Signature *

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