National Zach Shabbaton in Toronto
February 3-4, 2017 · Grades 7-8

at Shaarei Shomayim Congregation, Toronto
Members $85
 · Non-Members $100

THIS REGISTRATION FORM IS FOR TORONTO PARTICIPANTS ONLY
Montreal participants should email montreal@bneiakiva.org

Full Shabbaton details and program will be sent out the week before the Shabbaton

Participant's Name *
Participant's Name
Grade *
Emergency Contact Details
Parent's Cellphone Number *
Parent's Cellphone Number
Housing
Membership
I am a member of Bnei Akiva for the current year of 5777
Applications of non-members who pay the members' rate will be disregarded
Consent, Release and Waiver of Liability
By checking these boxes, we confirm to have read all of the information below and consent to all of the foregoing provisions. (Both must be checked.) *

By clicking "submit", we hereby grant our child permission to attend the Bnei Akiva National Zach Shabbaton in Toronto. In case of emergency we give permission for the designated First Aid provider to assist our child, and, if necessary, for him/her to be taken to a local doctor or hospital. We understand that any damage our child causes to the facilities around him/her or to property of others falls under our responsibility to replace and repair. We understand that Bnei Akiva is not responsible for any damage, theft or loss of personal items. We understand that if we withdraw our child from the event with one week's notice or less, no refund will be given.


CONSENT, RELEASE AND WAIVER OF LIABILITY for Bnei Akiva of Toronto trips and overnight retreats, within or outside of Canada, during the academic year 2016-2017 (hereinafter referred to as the “Trips”)

1. Consent
I here grant permission to myself/my child to attend the Trips, as established from time to time by Bnei Akiva of Toronto and communicated to the parents and participants.  In the event that I do not want to grant permission to myself/my child to participate in any specific trip, I agree that I will so advise Bnei Akiva of Toronto in writing no later than one day prior to the commencement of such trip, failing which this Consent, Release and Waiver of Liability will apply to such trip.

2. Acknowledgment and acceptance of risk
I recognize that participation in the Trips is voluntary and that there are certain inherent risks that participants, and their parents on their behalf, voluntarily assume.  I agree that the Bnei Akiva of Toronto, its employees, volunteers, representatives, directors and officers, shall not assume any responsibility for damages to or loss of my/my child’s property, myself/his/her illness, injury, or death while participating in the Trips.  By voluntarily participating in the Trips, I/my child and I freely assume any risk associated with or arising out of the Trips. I further understand and acknowledge that Bnei Akiva of Toronto cannot guarantee that while participating in any aspect of the Trips I/he/she will not come into contact with any allergens. By myself/my child participating in the Trips I/he/she is/am doing so voluntarily and with my express understanding of any potential risks including any associated with allergies my child has.

3. Insurance
I agree that it is my responsibility to ascertain whether I have adequate travel, health and accident coverage for myself/my child and to procure any other insurance coverage as I may deem necessary.

4. Waiver, release, indemnification and hold harmless
I understand and agree that there are unavoidable risks in travel and participation in the Trips.  As such, I do hereby forever and absolutely on behalf of myself/my child, myself, and any heirs, executors and assigns, waive and release any claims against Bnei Akiva of Toronto, its employees, volunteers, representatives, directors and officers, relating to my child’s participation in the Trips, including, but not limited to, claims for any injury, loss, damage or accident, delay or expense resulting from the use of any vehicle, any strikes, war, acts of terrorism, weather, sickness, quarantine, government restrictions or regulations.  I also agree to defend, indemnify and hold harmless, Bnei Akiva of Toronto, its employees, volunteers, representatives, directors and officers, from and against any and all liability, claims, lawsuits, judgments, losses, damages, and expenses, including reasonable attorneys’ fees, arising out of any financial obligations or liabilities that I/my child may personally incur or any damage or injury to his/her person or property or the person or property of others that I/he/she may cause, while participating in the Trips.

5. In the event of an emergency  
The trip chaperones or health care professionals, if any, participating in the Trips have authorization to order medical or surgical treatment deemed necessary for myself/my child.  In the event that I am not available for consultation, and in the event the trip chaperones or their designee determine that is advisable to seek medical attention for myself/my child, I give permission to an authorized representative of Bnei Akiva of Toronto to secure medical and/or surgical treatment for myself/my child.  I will hold Bnei Akiva of Toronto, its employees, volunteers, representatives, directors and officers, harmless from any liability, damages, costs, and expenses arising there from.

6. Severability
I agree that, should any provision or aspect of this Agreement be found to be unenforceable, that all remaining provisions of the Agreement will remain in full force and effect.

7. Governing law
I agree that if there is any dispute concerning myself/my child’s participating in the Trips or the interpretations of this Agreement, any such disagreement shall be determined in accordance with the laws of the Province of Ontario.

8. Entire agreement and modification
The terms and conditions of this Waiver and Release of Liability represent my complete understanding of the parties hereto with regard to myself/my child’s participation in the Trips and supersedes any previous or contemporaneous understandings I may have had with the Institutions on this subject, whether written or oral, and cannot be changed or amended in any way without the written concurrence of both the Institutions and me.