It is our pleasure to provide our families with as much support and service as possible. It is necessary, however, for the parents of our participants to assume responsibility for any risk associated with activities and time their child shares with his/her volunteers and/or at any Friendship Circle program or activity, whether it be in your home, Jewish Children’s Museum or elsewhere. This also includes the time when volunteers are driving the participant in their vehicles, or when one’s child is taking part in an activity that may include physical movement. 1. In exchange for the Friendship Circle permitting my child or family member to participate in any Friendship Circle program or activity (which provides a benefit to my child, myself, and my family). I, individually, and on behalf of my spouse and family, assigns, and personal representatives, in our personal and representative capacities (hereinafter “Releasers), hereby assume all risk of harm and hereby release, acquit, and forever discharge the Friendship Circle and their employees, volunteers, officers, directors, parent organizations, subsidiaries, affiliates, trustees, insurers, and representatives - (in their representative and individual capacities-) (hereinafter “FC Releases”) from any and all liability or claim whatsoever for any and all damages, losses, or injuries, including death, to persons or property or both, including but not limited to any claims, demands, actions, causes of action, damages, costs, expenses and attorneys' fees, which arise out of, during, or in connection with my participation, my families participation, and or our child's participation in any and all Friendship Circle Programs and activities, including but not limited to any damages, losses, or injuries to persons or property or both which may be sustained or suffered by me or any person in connection with my association with, participation in, or travel to and from, and in conjunction with, any and all Friendship Circle programs and activities. 2. I agree not to hold the FC Releases liable for any accident, loss or theft that may occur while my child is under their care. I hereby give my permission to the physician selected by the Friendship Circle to hospitalize, and/or secure necessary medical or other treatment or anesthesia for my child, (or any other family members who participate in any Friendship Circle program or activity) in the event that I cannot be reached in an emergency. I hereby give my permission for paramedics to transport my child or family member to the nearest hospital, if necessary. I have indicated any pertinent medical information on the Forms. 3. Releasers Expressly agree to indemnify, defend, and hold harmless the FC Releasers (in their individual and official capacities) from any and all liability, loss or damages they or any of them incur or sustain as a result of any claims, demands, damages, actions, causes of action, judgments, costs or expenses including attorneys' fees, which result from, arise out of, or relate to Releasers’ participation in, travel to and from, and/or in conjunction with any Friendship Circle program or activity. 4. I agree that this Waiver, Release, and Indemnification Agreement is intended to be as broad and inclusive as permitted by the laws of the State of New York, and if any portion hereof is held invalid, it is agreed that the balance hereof shall, notwithstanding, continue in full legal force in effect. To the extent necessary, I also specifically agree that any court of competent jurisdiction shall modify this agreement be declared illegal or unenforceable as written. The safety of program participants, as well as Friendship Circle staff and volunteers, is paramount. Therefore, in addition to undergoing a background check, the parents and/or guardians of any child participating in Friendship Circle activities must affirm the following, by checking the accompanying box: I agree to all of the above and allow my child to ride with any staff members or volunteers and I release them, the Friendship Circle of Brooklyn Inc., and the FC Releases referenced above of all responsibility and I, on behalf of myself and the Releasers above, assume all risk associated with any Friendship Circle program or activity. * I, agree to all of the above and allow my child to ride with any staff members or volunteers and I release them, the Friendship Circle of Brooklyn Inc., and the FC Releases referenced above of all responsibility and I, on behalf of myself and the Releasers above, assume all risk associated with any Friendship Circle program or activity. I hereby give permission for my child's photo to be displayed on any online websites or networks * I, hereby give permission for my child's photo to be displayed on any online websites or networks Criminal History No parent, legal guardian, siblings or others family members who will be present with the child participant at any Friendship Circle event, including the Friends@Home Program, have previously been convicted of, charged with, arrested for, or accused of sexual abuse of a child or young person, or any act of sexual misconduct, or of any crime of violence or involving the improper touching of another. Neither has any such person ever appeared on the Sex Offender Registry in any Country. I acknowledge that all information shared about any or all members of my family is confidential. I also acknowledge however, that it may be necessary for such information to be shared as needed by caregivers, staff, volunteers or other affiliates with the Friendship Circle. On behalf of myself and the Releasers above, and in exchange for allowing my child or family member to participate in any Friendship Circle program or activity; I agree to allow the Friendship Circle to discuss any information (including health or personal information) that is pertinent to my child/family member, and/or to their participation in any Friendship Circle programs or activity, with any or all relevant staff members, volunteers, or other affiliates with the Friendship Circle in order for Friendship Circle to offer optimal services to my family member. I acknowledge that all information shared about any or all members of my family is confidential. I also acknowledge however, that it may be necessary for such information to be shared as needed by caregivers, staff, volunteers or other affiliates with the Friendship Circle. On behalf of myself and the Releasers above, and in exchange for allowing my child or family member to participate in any Friendship Circle program or activity; I agree to allow the Friendship Circle to discuss any information (including health or personal information) that is pertinent to my child/family member, and/or to their participation in any Friendship Circle programs or activity, with any or all relevant staff members, volunteers, or other affiliates with the Friendship Circle in order for Friendship Circle to offer optimal services to my family member. We encourage direct communication with the Directors of the Friendship Circle regarding any and all safety matters or other matters which affected your or your child and their participation in any Friendship Circle program or any activity. Berel Majesky can be reached directly at 718-907-8835. All matters brought to the Directors’ attention will be investigated and addressed, and, to the extent reasonable or necessary in the context of any investigation, in a discreet manner. MEDICAL WAIVER My son/daughter has my permission to take part in Friendship Circle Programs. I agree not to hold the Friendship Circle liable for any accident, loss or theft that may occur while my child is under their care. I hereby give my permission to the physician selected by the Friendship Circle to hospitalize, and/or secure necessary treatment or anesthesia for my child, as named above, in the event that I cannot be reached in an emergency. I hereby give my permission that paramedics can transport my child to the nearest hospital, if necessary. I have indicated any pertinent medical information above. I agree to the terms and conditions of this application. Additionally, I am initialing below all that I am agreeing to by my signature below. I hereby give my child permission to participate in all activities planned by Friendship Circle I hereby give permission to administer medications to my child, upon my request as per written instructions (non-emergency).