JFGNO 2019 Youth Civil Rights Trip Enrollment and Waiver Form
This year's Jewish Federation of Greater New Orleans YOUTH CIVIL RIGHTS TRIP to Alabama will be held on November 26! Participants will be visiting: the Edmund Pettus Bridge in Selma; Temple Mishkan Israel in Selma; the Anne Frank Tree in Birmingham; the Sixteenth Street Baptist Church in Birmingham; and the Birmingham Civil Rights Institute. Transportation, meals, and admission fees for all students and chaperones will be provided. Please read the following waiver carefully and fill out the form below to enroll.
THE DEADLINE TO ENROLL IS OCTOBER 25.
Participants are expected to arrive at the Jewish Federation of Greater New Orleans building (3747 W. Esplanade Ave., Metairie, LA 7002) at 5:30am, with an estimated return to the building at 11:00pm. All students and chaperones will receive a FREE T-SHIRT to wear during the trip!
***CONFIRMATION OF ENROLLMENT AND WAIVER AND RELEASE OF LIABILITY***
I affirm that the student named below will be voluntarily participating in the Jewish Federation of Greater New Orleans (“JFGNO”) Youth Civil Rights Trip (the “Trip”) to Selma and Birmingham, Alabama, on November 26, 2019. I understand that participation in Trip activities could involve the risk of personal injury, illness, death, or property damage or loss and that JFGNO cannot and does not guarantee safety therefrom. JFGNO does not provide health and accident insurance for Trip participants, and I understand that any medical expenses, property loss, or other personal expenditures that result during or from this Trip are to be borne by the student or by their parent/guardian. I also hereby consent and give authorization to Trip leaders to secure any emergency medical treatment for the student during the Trip, and I agree to be responsible for the costs thereof. I additionally hereby grant permission to JFGNO to use photographs and/or video of the student taken on November 26, 2019 immediately before, during, and immediately after the Trip in publications, news releases, online, and in other communications related to the mission of JFGNO.
IN CONSIDERATION OF THE OPPORTUNITY AFFORDED FOR THE STUDENT TO PARTICIPATE IN THIS TRIP, I, ON BEHALF OF MYSELF AND THE STUDENT, ACKNOWLEDGE THAT THE STUDENT IS PARTICIPATING IN THE TRIP VOLUNTARILY AND AT HIS/HER OWN RISK; ASSUME ALL RISKS ASSOCIATED WITH THE TRIP; AND AGREE TO RELEASE, DISCHARGE, DEFEND, INDEMNIFY, AND HOLD HARMLESS JFGNO AND ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, AND REPRESENTATIVES FROM AND AGAINST ALL RIGHTS AND CLAIMS ARISING FROM ANY PERSONAL INJURY, DEATH, OR PROPERTY LOSS OR DAMAGE THAT THE STUDENT MAY SUFFER DURING, OR AS A RESULT OF, HIS/HER PARTICIPATION IN THE TRIP.
This release is intended to discharge JFGNO and its officers, directors, employees, and representatives from any and all liability arising from, or connected in any way with, the student’s participation in the Trip, even though that liability may arise from negligence or carelessness on the part of the persons or entities mentioned above, to the fullest extent permitted by law. The provisions of this Waiver and Release are severable. Should any part, term, or provision of this Waiver and Release be declared to be illegal or invalid, the validity of the remaining parts, terms, and provisions shall not be affected thereby, and said illegal or invalid part, term, or provision shall be deemed severable and not a part of this Waiver and Release.
Student's T-shirt Size (all sizes are Adult)
Parent's / Guardian's Name
Parent's / Guardian's E-mail Address
Parent's / Guardian's Phone Number (for emergencies)
How did you hear about this trip (school; religious institution; other)? Please be specific.
By entering your initials in the box below, you are effectively providing your signature.
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