I give my child permission to participate in LifeTown. I understand that participation in LifeTown activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and give consent for myself and/or my child to participate in this activity. I also understand that participation in this activity is entirely voluntary and requires participants to abide and be bound by all applicable rules and policies as set forth above and as well as any additional rules and policies pertinent to specific events, as it may be modified from time to time. I understand that this local LifeTown is independently owned, operated and controlled.
I release LifeTown, Friendship Circle and Chabad of Livingston and its employees, directors, officers, contractors and volunteers from any and all claims or liability arising out of this participation.
My child regularly participates in LifeTown. In addition, if I also provide a nurse or other type of caregiver (“Caregiver”) for my child during LifeTown program(s).
I agree to provide LifeTown with 24 hours’ notice or more in advance of each program that a new Caregiver will be accompanying my child. Additionally, I agree and fully comprehend that LifeTown cannot be held liable in any way for the conduct of said Caregiver or for anything arising out of the presence of the Caregiver in any way. I understand that this local LifeTown is independently owned, operated and controlled. I hereby release and agree to hold harmless and indemnify LifeTown and its employees, directors, officers, and volunteers, as well as its affiliates and all other organizations associated with LifeTown, from any and all claims or liability arising out of the participation
of my child and their Caregiver.
LifeTown provides very special and unique opportunities for volunteers, special friends and their families to enrich the lives of each other. In doing so, most participants will encounter new and sometimes challenging situations. Thus, it is imperative to set expectations at the beginning so that volunteers, special friends, and parents understand what they can expect. Therefore, volunteers, special friends, and their respective families each certify and agree to the following by signing below that I:
- Understand that participation in this activity is entirely voluntary and requires everyone to abide by applicable rules and standards of conduct;
- Understand that photographs can be private and sensitive and should not be shared by all.
- Do not use or possess any illegal drug, alcohol or controlled substances at any time, including at LifeTown events or programs;
- Do not have any alcohol or tobacco products at LifeTown events or programs;
- Do not bring any weapons, firearms or other dangerous items to any LifeTown event or program;
- Do not have any unsecured firearms in a home which hosts a Friends at Home program;
- Have not and do not have any individual that has been convicted of a crime, other than minor traffic violations, living at or visiting a home that hosts a Friends at Home program and have not themselves been convicted of a crime;
- Do not have any individual that has a history of violence or abuse of any kind living at or visiting a home that hosts a Friends at Home program;
- Agree to have a background check performed on me;
- Understand that participation in LifeTown activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for me and/or my child to participate in this activity and knowingly and freely assume all such risks;
- Will not participate in any activity that I believe I and/or my child cannot perform in accordance with the LifeTowns activities’ instructions or in a safe manner;
- If I observe any significant hazard during my or my child’s participation in any event or program, I will stop and/or have my child stop participating in the event and inform the LifeTown of such hazard immediately;
- Agree to abide by and perform everything stated in the Handbook in its entirety.
- Agree LifeTown is not responsible for any damages to personal property or injury in which the LifeTown had no knowledge of the particular hazard, or any activity outside of LifeTown sponsored events;
- Acknowledge that LifeTown is an independently owned, operated and controlled local corporation.
- Release LifeTown, the directors, board, officers, activity coordinators, and all employees, volunteers, related parties, and other organizations associated with the activity from any and all claims or liability arising out of this participation;
- Agree that in case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
