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SITY Summer 2021 Hangout Permission Slip

SITY's End-of-Summer Dance

~part of SITY's summer series of in-person, socially-distanced, outdoor events~

What: A camp-style dance, including a photo booth!
Where: Inner Richmond, details upon registration
When: August 7 @ 6:30 p.m.



 
I hereby certify that I am a parent and/or legal guardian of the participant(s) listed above and that I give my permission for them to participate in this event.
In the event of an accident or emergency, when a parent/guardian is unavailable, I hereby authorize a representative of Congregation Sherith Israel to make such arrangements as s/he considers necessary for my child(ren) to receive medical/hospital care, including necessary transportation. Under such circumstances, I further authorize the physician named below to undertake such care and treatment of my child(ren) as s/he considers necessary. In the event said physician is not available at any time, I authorize such care and treatment to be performed by any licensed physician or surgeon. I fully understand that I am responsible to pay all costs incurred as a result of the foregoing.
I hereby certify that my teen will NOT attend this event if they are experiencing new or worsening possible symptoms of COVID-19 (including fever or chills, cough, shortness of breath, loss of taste or smell, sore throat, vomiting or diarrhea) or have been exposed to a person known to be infected with COVID-19 (unless they have subsequently tested negative for COVID-19).
If you have previously given us your teen's medical information, you may write "N/A" in all medical information fields.
Wed, September 3 2025 10 Elul 5785