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By completing this Form, I give
my permission for my child,
,
to participate in Youth Programming for the
2011-2012/5772 year. I
hold harmless Congregation Kol Tikvah, The
Youth Department and/or individual Advisors
that may be part of this trip if any
injuries may incur in transit to/from or
during the event. I give Congregation Kol
Tikvah, or an agent of Congregation Kol
Tikvah in an advisor capacity for the Youth
Department, permission to have my child
treated at a medical facility in the event
of a medical emergency and I cannot be
contacted. I give Congregation Kol Tikvah
permission to use and publish any
photographs of my child from the event.
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