Karaoke & Candy for Teens (7th–12th Grade)

Saturday, September 27, 2025 • 5 Tishrei 5786

7:00 PM - 9:30 PM

Karaoke and Candy
7th-12th Graders
Saturday, September 27th from 7:00-9:30pm
In the Youth Lounge

* Parent / Guardian First Name

* Parent / Guardian Last Name

* Parent / Guardian Email

* Parent / Guardian Phone Number

* Child 1 First Name

* Child 1 Last Name

* Child 1 Grade

* Child 1 Contact Information

Child 2 First Name

Child 2 Last Name

Child 2 Grade

Child 2 Contact Information

Food Allergies

Please let me know if your student has any food allergies. If you would like to discuss this privately please feel free to contact me directly.

Release and Waiver of Liability

By checking the box below this form, I, the undersigned parent or legal guardian of the above-named participant, acknowledge and agree to the following:

Voluntary Participation
I understand that my child’s participation in activities, programs, or events organized by Valley Beth Shalom Synagogue Youth Department (hereafter referred to as “VBS”) is entirely voluntary.
Assumption of Risk
I am aware that participation in youth programming, events, field trips, and other activities may involve inherent risks, including but not limited to accidents, injuries, illness, or other unforeseen circumstances. I hereby assume all risks associated with my child’s participation in these activities.
Release of Liability
I release, discharge, and hold harmless VBS, its employees, agents, volunteers, and affiliates from any and all claims, liabilities, damages, or expenses arising out of or related to my child’s participation in VBS programs or activities. This includes, but is not limited to, claims arising from negligence or other acts or omissions by VBS or its representatives.
Medical Authorization
In the event of an emergency, I authorize VBS to seek and obtain appropriate medical care for my child. I understand that VBS will make reasonable efforts to contact me or the emergency contact provided below. I accept full financial responsibility for any medical treatment rendered to my child.
Behavior and Dismissal
I understand that VBS reserves the right to dismiss my child from any activity or program if their behavior is deemed unsafe, disruptive, or inappropriate. I will be responsible for any costs associated with early dismissal, including transportation.
Media Release
I grant permission for my child’s image, likeness, and/or voice to be used in photographs, videos, and promotional materials for VBS.
Indemnification
I agree to indemnify and hold harmless VBS from any claims, damages, or liabilities, including attorney’s fees, resulting from my child’s actions or participation in VBS activities.
Binding Agreement
This agreement is binding upon me, my child, and our respective heirs, successors, and assigns.

I have read, understand, and agree to the terms of this General Liability Waiver. By selecting this and submitting the form, I confirm my full consent for my child to participate in VBS activities under the conditions outlined.

* Emergency Contact Name

* Emergency Contact Relationship

* Emergency Contact Phone Number

* How many teens are you registering?