Holocaust Fellowship Registration

I will DO the following:

· Be WITH my group and chaperon at all times unless given explicit permission otherwise

· Stay in my HOTEL ROOM after curfew

· DRESS respectively and preserve the integrity of the Shabbaton

· Behave RESPECTFULLY toward anyone whose way of life differs from mine

· Behave as a JEW including observing KOSHER laws and keeping to CTeen’s standards

· Contact my chaperon immediately in case of EMERGENCY

I will NOT do the following:

· Carry or use any WEAPONS including, but not limited to, guns and knives

· Behave ILLEGALLY in any way

· ABUSE or BULLY anyone in any form

· Engage in any form of INTIMATE RELATIONS with anyone

· Intentionally DAMAGE or BREAK anything in my host’s home or Shabbaton venues

· Endanger the HEALTH, SAFETY, or WELFARE of my fellow Shabbaton participants

· SMOKE, buy, or possess cigarettes

· Drink, buy, or possess ALCOHOL or DRUGS

I have read these rules and understand them fully. I certify that I will adhere to this Code and will conduct myself in a manner reflecting credit upon my peers, my congregation, community and myself. I understand that any violation of this code of conduct may result in my being sent home at my parents' expense. The CTeen Director & Chaperones have the sole discretion to send a participant home.

I, the parent/guardian of, a minor, who will be participating in the CTeen of Roslyn's 2019 Washington Retreat, do hereby certify that I have read the Code of Conduct set forth above. I do hereby agree that if my child who has signed the above Rules of Conduct fails to adhere to the Code, then in such event those persons in charge of the program may send my child home at my expense. I understand that The CTeen Director & Chaperon's have the sole discretion to send my child home.

I have adequate medical coverage and insurance and give my child permission to attend the CTeen's Washington Retreat April 22 - April 24 and we (or I) agree to indemnify Jewish Youth Network, and all its officers, coaches and members for any claim which may hereafter be presented by our (or my) child as a result of any such injuries.

I (the parent or legal guardian) of the applicant state that he/she is in good/normal health, has no physical or mental handicaps that would interfere with full participation in the program and has my permission to engage in all available activities except as noted under Restrictions or Modifications above. I have been made aware of the fact that the events in which the likeness of my child is participating may be photographed by either amateur or professional photographers, and that the photographs may be used for purposes of reporting on the event, future publications or promotional material use as Jewish Youth Network may determine.

It is my understanding that by signing this document I consent to the use of the pictures just referred to for any purpose whatsoever.

In case of a medical emergency, accident or health problem where immediate treatment is deemed necessary, every effort will be made to expeditiously contact the parent(s) or guardian(s) of the participant, or the emergency contact person listed above. In the event I cannot be reached, I hereby give permission to the physician selected by The CTeen Director & Chaperons, or his/her designee, to hospitalize, secure proper and ongoing treatment and to order injection, anesthesia, or surgery for my child as named above. I fully agree to assume any financial responsibilities that may result from the aforementioned decision taken by the aforementioned individuals. I am aware that this form may be photocopied for use by medical caregivers.