IF YOU ARE ATTENDING ANY FRIENDSHIP CIRCLE EVENT THAT REQUIRES TRANSPORTATION, THIS FORM MUST BE ON FILE WITH THE JEWISH COMMUNITY CENTER, SONOMA COUNTY.
WE MUST HAVE AN UPDATED FORM EACH YEAR.
Thank you for your cooperation,
JALENA MAYS, Program Director
Consent for Emergency Treatment & Personal Confidential Questionnaire
I hereby authorize the escort of the trip to obtain medical treatment for me; I will be responsible for all payments.
I hereby waive, release and discharge any and all claims for damages, death, personal injury or property damage against the Jewish Community Center, Sonoma County, their staff, volunteers and agents for my participation in this activity.