Please read and sign the following authorization and release:
1. I hereby apply for the enrollment of my child for the Temple Aliyah SCJLL Retreat Weekend at Camp Ramah in California.
2. I understand that neither Temple Aliyah nor Camp Ramah is responsible for my child's personal property. I will receive a list of needed items prior to the weekend of the retreat. Both Temple Aliyah and Camp Ramah highly recommend that students not bring valuable items such as phones, music players, cameras, or expensive jewelry to the weekend.
3. I authorize the use of still and/or video photos and recordings of my child for publicity purposes by either Temple Aliyah and/or Camp Ramah.
4. The Camp Director and/or the Religious School Director and/or his/her representatives reserve the right to dismiss a child whose health, physical condition, mental condition, behavior, personal conduct, or influence on other campers is deemed detrimental to the weekend atmosphere. Should a child be dismissed in accordance with the conditions in this paragraph, no fees will be refunded.
5. I understand that part of the camping experience involves activities, group living arrangements, and interactions that may be new to my child. These things come with certain risks and uncertainties beyond what my child may be used to dealing with at home. I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk-free. I have instructed my child regarding the importance of abiding by the synagogue's and camp's rules. My child and I both agree that he/she/they is familiar with those rules and will obey them.
6. In case of an emergency, I hereby give permission to the Camp Director and/or the Temple Aliyah administration and/or their representatives to authorize the administration of health care service to my child by a physician or other professional health care provider (hospital, paramedic, nurse, etc.). I also give my permission ot the physician selected by the Camp Director/Temple Aliyah Administration/Representative to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child. It is understood that neither the Camp nor the Synagogue can assume responsibility for the payment, adequacy, or quality of service rendered by the physician or other health care providers selected in such an emergency. I also give my permission to the physician or camp personnel selected by the Camp Director to advise or treat my child for any illnesses or medical condition while he/she/they is at camp.
7. I authorize any physician, health care professional, hospital, clinic, laboratory, pharmacy, medical facility, health plan, or other health care provider (My Child's Providers) that has provided treatment or services to my child or on my child's behalf to disclose my child's entire medical record and any other protected health information concerning me or my child to Camp Ramah in California and Temple Aliyah and their agents, employees, and representatives. By signing below, I terminate any agreements I have made with My Child's Providers to restrict protected health information, and I instruct My Child's Providers to release and disclose my child's entire medical record without restriction.
8. The information on this form is both true and accurate, and I certify that I have not left out any health or medical information that would help either Camp Ramah or Temple Aliyah understand/work with my child.
