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QUESTIONNAIRE FOR EITANIM PROGRAM CANDIDATE

  • For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby authorize Israeli-American Council (IAC) permission to use my likeness in a photographic image(s) (photographs in any format, still, single, multiple, moving or video) in any and all of its publications, including but not limited to all Israeli-American Council (IAC), printed and digital publications and communications.
  • I understand and agree that any photographic image(s) using my likeness will become property of Israeli-American Council (IAC) and will not be returned.
  • I acknowledge that since my participation with Israeli-American Council (IAC) is voluntary, I will receive no financial compensation.
  • I hereby irrevocably authorize Israeli-American Council (IAC) to edit, alter, copy, exhibit, publish or distribute this photo(s) for purposes of publicizing Israeli-American Council (IAC) programs and events or for any other related, lawful purpose.
  • In addition, I waive the right to inspect or approve the finished product including written or electronic copy, wherein my likeness appears.
  • Additionally, I waive any rights to royalties or other compensation arising or related to the use of the photograph(s).
  • I hereby release the IAC, its contractors, clients, employees, officers, legal heirs, investors, agents, representatives, and assigns from all liability for any claims by me, my minor child, my family, my heirs, legal representatives and assigns or any third party in connection with my or my child’s participation, including any claims and demands ensuing from or in connection with the use of the photographic image(s), including any and all claims for libel and invasion of privacy.
  • I also release them from any expectation of confidentiality for the use of said photographs.
  • IAC Eitanim is a safe, caring community where individual differences are valued, where people are supported in reaching their goals and accomplishing challenges, and where everyone can have fun, work and learn. Because creating such a community requires the commitment of all participants, we ask everyone to agree to the behavior expectations.
  • Continued inappropriate behavior or severely inappropriate behavior (such as physical or emotional violence, bullying, or possession of prohibited items) will result in immediate dismissal from our program and forfeiture of program fees.
  • The parent/guardian is responsible for removing a dismissed student immediately.
  • We ask both the student and the parent/guardian to sign the Behavior Agreement section down below to confirm that you have read this document together and acknowledge and accept the responsibility to meet these behavior expectations
  • In order to open an Eitanim group we need a minimum of 15 participants.
  • If we do not reach the minimum number of participants, we will notify you, the parent registrant, of alternate dates/times for the sessions.
  • If the given options do not fit with your schedule you may request a cancellation and refund.
  • If you are forced to cancel your registration up to three weeks prior to the start of the program, a 20% cancellation fee will be deducted from your refund to cover registration process expenses.
  • In case of a cancellation, please email us at teens@israeliamerican.org
  • If a participant does not attend a session, they will not be eligible for a refund for that session.
  • IAC Eitanim does not provide recordings of a session.
  • If a participant does not comply with basic respectful behavior during the group sessions, or consistently interrupts the ability of the facilitator to hold the session-IAC Eitanim reserves the right to remove them from the session.
  • If the problem persists, IAC Eitanim reserves the right to remove the student from the remaining sessions as well.
RELEASE:
  • In consideration of the IAC allowing me and/or my minor child(ren) or ward(s) to attend and/or participate in any programs, events, classes, or other activities at the IAC and/or sponsored by the IAC, I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the IAC and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all rights and claims for any loss, damage, illness or injuries to person or property sustained as a result of my attendance and/or participation in any such programs, events, classes, and other activities, whether or not such loss, damage or injury results from the negligence of the IAC and its employees, agents, or representatives or from some other cause.
  • My agreement to release the IAC does not include any loss, damage or injury that results from the IAC's gross negligence or willful, wanton, or reckless misconduct.
  • I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es).
  • I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the IAC and its employees, agents, counselors, teachers, trainers, representatives, successors and assigns, from and against any and all liability, claims, losses, costs, expenses or damages for libel, slander, invasion of privacy, conversion, defamation, appropriation of likeness or any other claim based on the use of my and/or my minor child(ren)’s or ward(s)’ name(s) and/or likeness(es) in any such materials.
INDEMNIFICATION:
  • I hereby represent and warrant to the IAC that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable.
  • In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s), or any other person nevertheless asserts any claim against the IAC arising out of my or my minor child(ren)’s or ward(s)’ participation in any program, event, class or other activity as set forth herein.
  • I agree to indemnify, hold harmless and defend the IAC from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the IAC or from some other cause.
ACCEPTANCE:
  • I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form.
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