acknowledge and grant
consent for student to participate in the Jewish Program (the “Program”).
Waiver: In consideration of being permitted to participate in the Jewish Youth Club (JYC) Program, I, for
myself, my heirs, personal representatives of assigns, do hereby release, waive, discharge, and covenant
not to sue The Jewish Youth Club (JYC) , its officers, employees, and agents from liability from any and all
claims, including the negligence of The Jewish Youth Club (JYC) , its officers, employees and agents,
resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but
not limited to, participation in the program.
Assumption of Risks: Participation in the program carries with it certain inherent risks that cannot be
eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to
another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains, 2) major
injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, 3)
catastrophic injuries including paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that
are inherent in the Jewish Youth Club (JYC) Program. I hereby assert that my participation is voluntary and
I knowingly assume all such risks.
Indemnification and Hold Harmless: I agree to INDEMNIFY AND HOLD The Jewish Youth Club (JYC) and
it's staff HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and
liabilities, including attorney’s fees brought as a result of my involvement in the program and to
reimburse them for any such expenses incurred.
Severability: The undersigned further expressly agrees that this Indemnity agreement is intended to be
as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof
is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding: I have read this Indemnity agreement, fully understand its terms,
and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am
signing the agreement freely and voluntarily, and intend by my signature to be a complete and
unconditional release of all liability to the greatest extent allowed by law.
Photo/Video Authorization and Release: I hereby authorize The Jewish Youth Club (JYC) (the “JYC”)
and its officers, agents, and employees to photograph, film, videotape, or record the student and use
their name, voice and/or likeness in such photograph, film, video, or other recording taken or made by
the JYC or provided by the student.
I understand that any photograph, sound recording, motion picture, or video or other recording taken of
or provided by the student under this agreement (“Material”) can be used for any purpose including
serving the Jewish Youth Club (JYC)'s mission of education, and public service, and for promoting the
public good.
I hereby assign to the JYC all rights, title, and interest, including copyright and rights of publicity that
the student may have in and to any and all such Materials. I hereby irrevocably authorize the JYC, its
officers, agents, and employees, without limitation, to reproduce, copy, sell, exhibit, publish, or
distribute any and all such Materials in perpetuity. I enter into this agreement for good and valuable
consideration, the receipt and sufficiency of which I acknowledge, and under-stand and agree that I will
not receive monetary payment for any use of the Material by JYC.
I further release and forever discharge and agree to hold harmless the JYC, its officers, agents, and
employees from any and all claims and demands—including but not limited to any and all claims for
violation of rights of publicity, invasion of privacy, libel, defamation, or copyright infringement.
I have read and understood the provisions of this agreement, and understand that I am free to obtain
advice from legal counsel of my choice, at my expense, to interpret these provisions. By signing below, I
acknowledge that I have freely and voluntarily entered into this agreement.
Medical Care Consent and Waiver. I authorize the JYC to provide emergency first aid and to consent to
medical assistance, transportation, and emergency medical services on my behalf. This consent does not
impose a duty upon the JYC to provide such assistance, transportation, or services. In addition, I waive and
release any claims against the Released Parties arising out of any first aid, treatment, or medical service,
including the lack or timing of such, made in connection with my participation in activities with the JYC.
