I hereby give permission for my child named above to participate in the SLEEPOVER AT THE SHUL EVENT with Temple Emanuel of Beverly Hills and do release Temple Emanuel of Beverly Hills and its representatives from all liability arising out of my childâs participation in this activity.
I understand that if my child breaks any rules set forth in the code of conduct outlined by the person in charge be subject to disciplinary action by the person in charge including, but not limited to, expulsion from any event, in which case it is the parentsâ responsibility to pick them up from the temple immediately on the request of the person in charge, with no refund of monies paid. All participants must remain at the event for the full duration. Late arrival to or early departure from any program must be agreed upon by the person in charge ahead of time and must include parental consent.
In addition, I the undersigned Parent/Guardian of the above child do further certify that my child is physically able to participate in such activity and hereby authorize Temple Emanuel of Beverly Hills and its authorized representatives as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is to be rendered under the general or specific supervision of any licensed physician or dentist under the provision of the California Medicine Practice Act and Dental Practice Act or the staff of a licensed hospital, whether such diagnosis, examination or treatment is rendered at the office of said physician, or such hospital.
It is understood that the authorization is given in advance of any specific examination, diagnosis, treatment or hospital care being required, and is given to provide authority and power of our above named gents to give specific consent to any and all such examinations, diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. THE AUTHORIZED IS GIVEN PURSUANT TO PROVISION OF SECTION 25.8 OF THE CIVIL CODE CALIFORNIA.
I HAVE READ AND FULLY AGREE TO THE MEDICAL /LIABILITY FORM ABOVE.