Ignite Detailed Registration Form 2022-2023

Bar/Bat Mitzvah Student's Information

Student's Name*

First NameLast Name

Birth Date*

MonthDayYear

School*

Grade*

Bar/Bat Mitzvah Date

Date

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student's Phone Number

Area CodePhone Number

Student's Email

example@example.com

Parent/Guardian Information

Father's Name*

First NameLast Name

Mother's Name*

First NameLast Name

Father's Cell Number*

Area CodePhone Number

Mother's Cell Number*

Area CodePhone Number

Father's E-mail*

Mother's Email*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

If your child has any allergies, chronic illness, or medical conditions, please describe here.

Details

There are 7 local Ignite trips planned for this year as well as a 2 day trip to LA. In addition to the local trips, the Ignite program has partnered with Denver NCSY. Free admission to all local Junior NCSY trips is included with Ignite tuition. Each Ignite student is also encouraged to attend the weekly Junior NCSY gathering each Wednesday night from 6pm-7pm, at Aish of the Rockies. The weekly gathering will help build a more cohesive group as well as introduce our students to other Jewish, Middle School, students. The program also includes 5 individual learning sessions where each student will work to process the education one on one with their guide. You will be contacted by your child's guide to schedule the individual sessions throughout the school year.

1. Each Bar/Bat Mitzvah will be matched with their Guide

(Counselor) to work with throughout the program. Their
Guide will work to help them process everything in a
way that is most suited to their strengths and interests.

2. Each Bar/Bat Mitzvah will be given homework
after each group trip to stimulate them to process
what they have experienced. They will review their
work with their Guide in the Individual sessions.

3. During Individual sessions, the Bar/Bat Mitzvah can
work on additional goals with their Guide. However,
this program in NOT designed to teach Bnei Mitzvah
students large amounts of Torah or Tefilla reading.

4. The goal for each group trip is to have the Bnei Mitzvah
working in settings that will educate them in meaningful
Jewish values. Most of the group trips will involve the Bnei
Mitzvah volunteering as a group in one or more settings.

5. A calendar containing the dates of the group trips will
be given out at the beginning of the program and a
complete itinerary for each group trip will be sent a
week or two in advance. Expect each group trip to be at
least a half day trip. The final trip will be 2 days long.

6. We will encourage our graduates to stay connected
and share their ongoing commitments with each other
in effort to inspire lifelong involvement in Judaism.

7. The cost for the Bnei Mitzvah for Life program is $1,500
for each Bar or Bat Mitzvah child (excluding airfare,
approximately $300).

YesNoOther

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Aish of the Rockies during the Ignite Program. In exchange for the acceptance of said child’s candidacy by Aish of the Rockies in the Ignite Program. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Aish of the Rockies and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from Ignite Program sessions.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Aish of the Rockies and its affiliates including Directors, Guides, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

COVID 19 Waiver and Assumption of Risk

To the Members and people who use are going to be using the Aish Building located at 9550 E Belleview Ave, Greenwood Village, CO, including all of its facilities, or joining any of the Aish, and/or joint Aish and NCSY, in-person programming.

Due to the 2019, 2020 and 2021 outbreak of the novel Coronavirus (COVID-19), Southeast Center for Judaism, Inc. d/b/a Aish of The Rockies is taking extra precautions with the care the building and facilities to enhanced sanitation/disinfection procedures in accordance with the Colorado Department of Public Health and Environment including working closely with the Centers for Disease Control and Prevention.

(CDC) Symptoms of COVID-19 might include:

Fever. Fatigue. Dry Cough. Difficulty Breathing. Muscle aching. Loss of taste and/or smell.

(The above list is not exclusive and if any doubt as to your health status, please consult with a medical provider of your own choice)

In consideration of the use of the Aish Building, or joining any of the Aish and/or joint Aish and NCSY in-person programs whether at the Aish building or any other location, it is agreed:

1. I understand, covenant and agree that Aish of the Rockies and NCSY, it employees, officers, directors and/or members cannot be held liable for any potential or actual exposure to the COVID-19 virus and I assume all risk of any type associated with the use of the Aish Building and/or of any facilities, and with joining any in-person programming at any location. I understand there is a constant present and active risk that I or who ever else uses the Aish Building or joins an in-person program at any location, may be exposed to the COVID-19 Virus and I voluntarily assume this risk, covenant and agree not to sue and/or to enforce a judgment against Aish of the Rockies and/or NCSY voluntary waiving any and all claims. In reliance to the covenants and agreements, Aish of the Rockies will allow you the use of the Aish Building and/or its facilities and to join in-person programming at any location, in accordance with its rules, regulations, and schedules. No other person my use the Aish Building or join in-person programming at any location except acknowledging party

2. I agree to each statement above and fully and completely assume any and all risks of any and all types during my use of the Aish Building and/or participation at in-person programming in any location. This agreement will stay in full force and effect until withdrawn by Aish of Rockies. This agreement is binding on the acknowledging Party, his/her heirs, assigns and succors according to the laws of the State of Colorado.

3. Members or Users in using the Aish Building and its facilities and participants in Aish and joint Aish and NCSY in-person programming do hereby covenant and agree to indemnify to the greatest extent allowed by law and will forever defend any claims made by any party for claimed injuries, damages or any kind of loss for COVID 19 made against Aish of Rockies, NCSY, their Rabbis, officers, directors, members, employees or independent contractors that provide services to Aish of the Rockies and/or NCSY because of the use of the Aish Building and/or participation in in-person programming by the Acknowledging Party Member or User.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

By Signing below, you are affirming that you have read the details of this application and that you consent to all of its sections. *

My Products

Pay in 8 Installments$187.50

Pay in full upfront$1,500.00

Paid by Check$ Free

Please send the check to Aish office and mark for Ignite

Enter coupon

Total $0.00

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Ignite Registration Form