Consent, Indemnity & Waiver
Please note: forms will not be considered if this documentation is not completed and signed accordingly.
I, the undersigned
(hereinafter referred to as “the guardian”), in my capacity as legal guardian of
(hereinafter referred to as “the applicant”), herewith request permission for the applicant to attend
“Machaneh Lazuz” (hereinafter referred to as “the event”) which is to be held at
Rotary Campsite, Glen Cairn from
3rd December 2012 to
27th December 2012 or at such other time
(see age group specific camp dates) and or place as the organisers, as defined herein, in their sole discretion decide, do hereby;
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Acknowledge that the organisers, as defined below, reserve the right to refuse to grant to the applicant permission to participate in and / or attend the event.
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Certify that all the information contained in these forms is true and correct and that no material information whatsoever has been withheld and I acknowledge that any incorrect information may lead to this application being refused or the organisers, as defined below, terminating the applicant’s participation in terms of clause 8.1 below or sending the applicant home in terms of clause 8.2 below.
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Undertake to abide by the rules, regulations and procedures of the event and in particular, without derogating from the generality of the foregoing, the rules, regulations and procedures relating to visits to or communications with the applicant during the course of the event with which rules and regulations I acknowledge myself to be acquainted.
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Undertake to pay, on demand, all amounts payable in connection with the applicant’s attendance at the event or reasonably ancillary thereto, including, without limiting the generality of the a foregoing, expenses incurred for the transportation of the applicant to and from the event;
5. 5.1 Indemnify the
madrichim (youth leaders) in charge of the event, the South African Zionist Youth Council, the South African Zionist Federation, South African Union of Progressive Judaism and any of its affiliated and/or constituent bodies and directorates and/or any representative, employee, servant or agent of any of the a foregoing bodies or persons (hereinafter referred to as “the organisers”) against any claim whatsoever and howsoever arising which may be made against them or any of them by any person and/or against any liability which may be incurred by and/or damage which may be suffered by them or any of them, arising directly or indirectly out of any act or omission of any nature whatsoever, whether negligent or otherwise (including gross negligence), on the part of the applicant.
5.2 Undertake that such claim and/or liability and/or damage will be fully paid on demand by me and/or the applicant up on the organisers or any of them being called upon to make any such payment;
6. Agree that the following provisions shall apply in respect of any claim of any nature whatsoever which I or the applicant may have or hereafter have against any one or more of the organisers in respect of any loss, damage, injury or death to the person or property of the applicant, howsoever caused, namely:
6.1. Any such claim shall be notified to the organisers, in writing, as soon as practicable after the event giving rise to such claim shall have occurred.
6.2 The organisers shall, as soon as reasonably practicable after the receipt of any such claim, forward such claim to their insurers in accordance with the terms of such insurance policies as the organisers may from time to time hold in respect of public liability cover and/or personal accident cover.
6.3 To the extent that the insurers pay any amount in respect of any such claim to the organisers, the organisers shall, in turn, pay such amount to the claimant, such payment to the claimant shall constitute a full and final settlement of any such claim as against the organisers.
6.4 Save as aforesaid, the organisers shall have no liability whatsoever in respect of any such claim, it being recorded that the organisers do not warrant that any amount will be paid by their insurers in respect of any such claim.
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Designate the director of the event (“the director”) or any such other person duly appointed by him/her (“the appointee”) to act in loco parentis on my behalf during the course of the event. In particular, but without derogating from the generality of the a foregoing, the director or his/her appointee shall in his/her sole discretion have the authority to give permission for any emergency operation or other medical treatment required by the applicant during the course of the event and to incur, as agent on my behalf, all expenses flowing there from, which I undertake to pay on demand, and I hereby authorise the director or his/her appointee irrevocably and in rem suam to take all such steps necessary to give effect to the provisions of this clause 7;
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Agree that: -
8.1 the director or his/her appointee shall have the right at any time during the course of the event to terminate the applicant’s participation therein and to send the applicant home, if, in his/her sole discretion, it is considered advisable for any reason whatsoever;
8.2 the director or his/her appointee may, acting as my agent, send the applicant home at my cost by any reasonable means of transportation which he/she may in his/her sole discretion determine and I hereby authorise the director or his/her appointee irrevocably and in rem suam to take whatever steps necessary to give effect to the provisions of this clause 8.2;
8.3 I and/or the applicant shall pay, on demand, to the organisers all expenses so incurred in terms of clause 8.2 above and indemnify the organisers against any claim which may be made against then in this regard, and acknowledge that there shall be no refund of any payments made by me and/or the applicant for the unexpired period of the event;
8.4 should the applicant be sent home in terms of clause 8.1 above, the applicant shall not be permitted to participate in and/or attend any other event organised by the organisers or any of them, unless the director in his / her sole discretion, decides otherwise;
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Accept that, in the event that the applicant being unable for any reason whatsoever to attend or participate in the event for the full period thereof or at all, neither the applicant nor I shall have any claim for a refund of the fees already paid in respect of the event, unless the organisers in their sole discretion decide otherwise.
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Acknowledge that each of the a foregoing provisions are severable from the other and may be enforced against me and/or the applicant separately from any other provision.
Returning the application form
Please note that forms should be scanned and e-mailed to camp@netzer.org.za. Alternatively, detach the application portion of this camp form, and return to:
Cape Town
By post and hand:
5 Salisbury Road
Wynberg
7700
Forms can also be handed in at Temple Israel Green Point or faxed to 021 797 8309.
Queries: Nina – 071 612 9977
Durban
Post to the Johannesburg address.
Forms can also be handed in at Temple David offices or faxed to 031 209 2429.
Queries: Dayne -082 698 5310
Gauteng and Smaller Sniffim
By post and hand:
38 Oxford Road
Parktown
2193
Johannesburg
Forms can also be handed in at Beit Emanuel, Bet David or Bet Menorah offices or faxed to 011 646 5543.
Queries: Sivan - 082 855 5199
Visitors’ Day
Experience a taste of Netzer at Machaneh to see what it’s all about
A light lunch will be served before an afternoon filled with entertainment.
It is an afternoon not to be missed.
Date: Sunday 23 December
Time: 11:00 am
Location: Rotary camp site, Glen Road, Glen Cairn
RSVP: Booking Essential. Before November 30th
Cost: R60 for adults, R40 for children. Payment on entrance.
Contact: camp@netzer.org.za
Items 2, 3, 5 and 6 can be considered criminal activities, and Netzer South Africa will not protect perpetrators from the law.
Items 1, 2, 3, 4 and 5 are offences for which the camper will be sent home immediately. The travel costs for this early departure will be covered by the camper or his/her parents.
We strongly discourage bringing any valuables to camp.
Netzer South Africa does not take responsibility for the loss and/or damage of any property brought on site and/or confiscated.
Li and Michael Zeffertt Carolyn and Tim Hoffman Leigh Whitesman and Peter Mayson Ted Riese Bryan and Dyann Segel Trevor and Patti Zway Sylvia and Glenn Brazil
Gareth Hall Jarred Durbach Talia Mayson Lauren Kessler Talya Davidoff Jackie Maris Maia Zway Hayley Kornblum Casey Wolfson