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Teen Lounge

Wednesday, February 20, 2019 • 15 Adar I 5779

6:30 PM - 8:30 PMCommunity Room B

Join your peers for an awesome evening of hanging out around the world in the teen lounge! We'll have food & activities from different countries from around the world and have a great evening together with new & old friends!

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Someone other than a parent please


Medical Release and Liability:

I hereby grant permission for my child to participate in all Temple Sinai youth programs, activities, field trips and events and do hereby release Temple Sinai, Inc., its respective directors, officers and employees of and from any and all claims whatsoever arising or which may arise by reason of my child’s participation in the programs, activities, field trips and events, including any claims due to personal injuries or illness.

 

In addition, I, the undersigned parent/guardian of the above child, do further certify that my child is physically able to participate in such activities and hereby authorize Temple Sinai 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 the staff of a licensed hospital, whether such diagnosis, examination or treatment is rendered at the office of the said physician, or at such hospital.

 

It is understood that this authorization is given in advance of any specific examination, diagnosis, treatment, or hospital care being required, and is given to provide authority and power on the part of our above named agents 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 undersigned agrees to bear the costs of all medical care and procedures required by the Child. The undersigned also agrees to maintain appropriate medical insurance coverage for the Child while participating in the temple’s programs, activities, field trips and events. The undersigned hereby releases Temple Sinai Inc., its respective directors, officers and employees from any claim arising out of any medical treatment the Child may require.

 

I have carefully read the above Medical Release and Liability Waiver and understand the terms and conditions of it and agree to be bound thereby.

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Tue, February 19 2019 14 Adar I 5779