This waiver & Release of Claims, and Consent, and Medical Emergency Authorization (“Waiver & Release”) is signed in conjunction with the attendance at Fox Valley Jewish School (FVJS) at Fox Valley Jewish Neighbors (FVJN) of
(“Student”), who is a minor child (“Student”) and whose parent or legal guardian is
and who, with or without other family members, may from time-to–time be accompanying Student to Fox
Jewish School at FVJN.
Waiver and Release of Claims
Please read this Waiver & Release carefully, and be aware that by registering Student for
participation in FVJS, you will be waiving and releasing all claims against FVJN, FVJS
and related parties for injuries, damages or other losses that you and/or Student may
suffer as a result of, arising out of, related to or in connection with Student’s and/or your
participation in and/or attendance at FVJS.
By signing below, you acknowledge that:
You understand that health insurance and accident insurance that you may have are your financial protection in the event of injury to Student and/or you, including while Student and/or you are participating in and/or attending FVJS.
You recognize and acknowledge that there are certain risks of physical and/or mental injury to participants in and attendees of the FVJS, including to Student and yourself and any other family members who accompany Student to FVJS.
You waive, release, and relinquish all claims, whether known or unknown, which you and/or Student and/or any other member of your family may have, may have had, or may some day have, against FVJS, FVJN and/or its directors, officers, agents, managing agents, contractors, volunteers, contributors, sponsors, employees and/or related individuals or entities (collectively, the “FVJN Parties”) as a result of, arising out of, related to, or in connection with the FVJS, including claims for injuries, damages or losses.
You agree to indemnify, hold harmless and defend FVJS, FVJN, and the FJVN Parties from all claims arising out of, related to, or resulting from injuries, damages and losses of any kind, whether known or unknown, sustained by Student and/or you and/or any other member of your family, as a result of, arising out of, related to, or in connection with the FVJS.
Consent to Participate
By signing below, you acknowledge that you are giving Student permission to participate
in and attend the FVJS; and you confirms that in the event that you and/or any other
member of your family, participate in and/or attend the FVJS, that you have voluntarily
chosen for yourself and all such family members to so attend.
As parent and/or legal guardian to Student, by signing below you acknowledge that you
are authorizing the following: Treatment by a qualified and licensed medical doctor of
Student and/or you and/or any other member of your family in the event of a medical
emergency that arises for Student and/or you and/or any other member of your family
while attending and/or participating in the FVJS, if ,in the opinion of the attending
physician, the delaying of medical treatment may endanger Student’s and/or your life
and/or any other member of your family, as the case may be, or cause disfigurement,
physical impairment , or undue discomfort.
By signing below, you acknowledge that you have read fully and understand this Waiver
& Release of Claims, and Consent to Participate, and Medical Authorization.
FVJN is located at:
121 S. Third St.
Geneva, IL 60134
PO Box 346, Geneva, IL 60134