For Parents and/or Legal Guardians
This is a Legal Agreement, please review it carefully.
Our Child, whose names is set forth below, has applied to participate in Chai Lifeline’s Camp Lifeline and its related side trips, outings and activities (collectively referred to as “Camp Lifeline” or as “participating in Camp Lifeline”).
In exchange for giving our child the opportunity to participate in Camp Lifeline at no charge, in recognition of Chai Lifeline’s status as a community-based-not-for-profit organization, and in the event out Child participates in other Chai Lifeline programs currently or in the future, we acknowledge, understand and agree as follows:
That, while Chai Lifeline will endeavor to operate Camp Lifeline in accordance with generally accepted standards, it accepts no responsibility for the above Risks, unless damages to our Child are caused directly by the gross negligence of Chai Lifeline, or by the gross negligence of one of its employees, volunteers, agents or representatives (collectively, the “Agents”);
That we understand, accept, and assume any and all such Risks, on our own behalf, and on behalf of our Child
That we give our unqualified permission and our consent to Chai Lifeline to permit it to take our Child and have him/her participate in Camp Lifeline, and all of its related side trips, outings and activities, and authorize Chai Lifeline to exercise its discretion in the implementation of all aspects of Camp Lifeline and, specifically our Child’s participation in Camp Lifeline;
That we agree to release and hold harmless Chai Lifeline and its Agents from any claims costs, expenses and/or damages which our Child may sustain or incur as a result of participating in Camp Lifeline (collectively, the “Damages”), except to the extent that such Damages are directly caused by the gross negligence of Chai Lifeline or its Agents;
That routine medical needs and emergencies affecting our Child may arise during the course of Camp Lifeline (collectively “Medical Needs”), and that I may be impossible or impractical for Chai Lifeline or its Agents to reach us during the course of Camp Lifeline. We therefore agree and authorize Chai Lifeline and its Agents in advance and at all times during Camp Lifeline to use reasonable efforts and judgment:
To assess the Medical Needs of our Child and, if deemed necessary;
To seek medical treatment and/or services on behalf of our Child to address the Medical Needs including, but not limited to, the transport of our Child to secure medical treatment at emergency room and/or hospital, and to give consent on our behalf to medical professionals to authorize the treatment of our Child at such facilities
To provide a copy of this permission form to any and all treating medical professionals; and
To receive, transmit and exchange any and all medical information of any nature deemed reasonably necessary for the care of our Child to address the Medical Needs;
That we agree to accept full financial responsibility for any costs and expenses incurred by Chai Lifeline in connection with its efforts to attend to the Medical Needs of our Child and;
That while your Child is in Camp, he/she will most likely be photographed and videotaped several times a day. These photos are videos are used in several ways; internally in Camp, (including camp newsletter, videos, slideshow, photo books etc…)and on Chai Lifeline/Camp Lifeline web sites. Your Child is as precious to us as they are to you. All photos used with the understanding that there will be no exploitation of any child and that any photography and/or videotapes used will conform to standards of good taste.
