Mezuzah Workshop Youth Safety and Release Form

Please copy and paste this form into a Word document and fill it out.  Email it to [email protected].

1.) Participants must wear close toed shoes (leather preferred), long pants (denim is preferred). No skirts, dresses, yoga pants.

2.) Wear cotton or wool blends only please.  (Avoid limit polyester)

3.) Tie Back long hair or bring a hair tie.

4.)  If participant wears glasses, bring them.

5.)  Arrive rested and fed, bring a healthy snack and lunch.

6.)  The garage can be chilly, wear layers.

7.)  Classes run on time.  Plan to arrive 15 minutes early.

I give permission for my child, ___________________________, to attend Aimee and David’s Mezuzah Camp and to receive emergency medical treatment if I cannot be located. I hereby authorize Aimee and David to act for me to their best judgment in any case of emergency requiring medical attention.  ________ (initials)

I have read, understand and will comply with the above listed safety rules.  I understand that further safety demonstrations will take place during the workshop, including but not limited to torch and hand tool safety.   ________ (initials)

I hereby waive and release  Aimee and David at 167 Caine Ave, SF CA 94112 from any and all liability for injuries or illnesses incurred while at Mezuzah Camp. I have no knowledge of any physical impairment that would be a affected by the named camper’s participation in Mezuzah Camp.     _______ (initials)

I also understand that Mezuzah Camp may retain the right to use for publicity and advertising purposes, photographs of campers and artwork taken at Mezuzah Camp. ________ (initials)

Please note that Mezuzah Camp run by Aimee Golant and David Casella is an independently run program separate from Brandeis School of San Francisco.    ________ (initials)

I would like to be notified of future workshops.  ____________________________ (email address)

Date:___________  Signature of Parent or Guardian ______________________________________

Parent Contact Phone Numbers: _______________________________________________________

Parent email: __________________________________________________________________________

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