PARENT AGREEMENT FOR USE OF THIRD-PARTY TRANSPORTATION SERVICE Yeshiva Elementary, Inc. has arranged with a third-party vendor to provide bus transportation for students to and from Yeshiva Elementary School ( YES ), located at 7902 Carlyle Avenue, Miami Beach, Florida. This third-party service is not mandatory, and is intended to provide an additional convenient transportation option for those families who may want it. Please read this form carefully, as it provides important information, rules, and guidelines. If you wish to use this service, please complete the form and return it to YES by July 31, 2015. Rules and Guidelines A parent, legal guardian, or other adult of eighteen (18) years or older assigned by said parent or legal guardian (named at the end of this agreement) must sign an attendance form before any child enters or exits the bus. The daily attendance form may not be signed by a sibling or any other nonguardian of the child (apart from those named below). Failure to follow this procedure may result in loss of service for the parent or guardian. YES may decide to place monitors on the bus, at its sole discretion. These bus monitors will serve as representatives of YES while on the bus and will, to the extent possible, ensure safety and proper behavior and enforce school rules. Please be aware that YES has no obligation to place monitors on the bus and may not do so in many instances. At all times, the bus driver (who is an employee of the third-party vendor) shall remain in charge of the bus routes. If, in the estimation of the bus driver a child is acting in a manner that is deemed threatening, dangerous or harmful to himself/herself or any other child or group of children on the school bus, the child may be disciplined in a manner deemed appropriate by the bus driver. Due to the safety of the children, the bus driver is allowed to refuse to further service a child as a result of said misbehavior. In such an event, the prepaid bus fee will not be refunded in part or whole thereof. The bus may or may not have seatbelts. In the event that any damage to the bus, equipment or property belonging to the third-party vendor, or equipment or property belonging to YES, is caused by your child, you acknowledge and agree that you will be held liable for any and all costs associated with any actions of neglect or recklessness. Payment for Transportation Service The fee for the service will only be refundable, on a pro-rated basis, if the bus company decides to withdraw the offer of service to the entire group. Consent for Emergency Medical Care This form grants temporary authority to the supervisory staff of YES to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians, and it may not be feasible or practical to contact them. Page 1 of 5
I grant authorization and consent for the supervisory staff of Yeshiva Elementary School to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the supervisory staff of YES to summon any and all professional emergency personnel to attend, transport, and treat the minor and to issue consent for any medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the State of Florida. I agree to assume financial responsibility for all expenses of such care, and I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event of an emergency, please contact the following person(s) in the order presented: Emergency Contact Contact Relationship Contact Telephone Number Waiver and Release of Liability In consideration of the risk of injury while participating in the third-party bus transportation services to and/or from Yeshiva Elementary School (the Activity ), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Yeshiva Elementary Inc., located at 7902 Carlyle Ave, Miami Beach, Florida 33141, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I am voluntarily participating in the aforementioned Activity and I am participating in the Activity entirely at my own risk. I am aware of the risks associated with participating in this Activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own negligence or the negligence of others, or other risks inherent to the Activity, including, but not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event Page 2 of 5
officials monitors, and/or employees or agents of the third-party bus service. Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during this Activity. I acknowledge that Yeshiva Elementary Inc. and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Yeshiva Elementary Inc. I agree to indemnify and hold harmless Yeshiva Elementary Inc. against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Yeshiva Elementary Inc. incurs any of these types of expenses, I agree to reimburse Yeshiva Elementary Inc. I acknowledge that I have carefully read this waiver and release and fully understand that it is a release of liability. I expressly agree to release and discharge Yeshiva Elementary Inc. and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Yeshiva Elementary Inc. for personal injury or property damage including any claim for attorneys fees or costs. I acknowledge that I have entered into this Agreement without duress or coercion, and I agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Agreement shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this Agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. Execution and Acknowledgements I, the undersigned parent or guardian, understand that Yeshiva Elementary Inc. has arranged this third-party service as a convenience for the families of the children enrolled at the school. I understand that this third-party service is not required and that I choose to enroll my child voluntarily. I affirm that I am of the age of eighteen (18) years or older, and that I am voluntarily signing this Agreement. I certify that I am the parent or legal guardian of the minor identified below and that I give my consent to the foregoing on behalf of this minor. I further certify that I have read this Agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will. By signing this Agreement, I Page 3 of 5
acknowledge and understand that I am waiving my right to sue or bring any form of litigation against Yeshiva Elementary, Inc. in connection to the bus transportation service administered by a third-party. I understand the above information and agree to abide by the rules and guidelines outlined above. Parent or Guardian s Name: Name(s) of Minor(s): Relationship to Minor(s): Parent or Guardian s Address: I authorize the following named adults to sign my child/ren on and/or off the bus. Signature: Date: Page 4 of 5
Miami Beach Bus Sign Up Form Please choose which option(s) you would like and fill out the form below: Option 1: Round trip * Morning pick up to arrive at school 8:25am * Afternoon pick up from school at 4pm or 5pm dismissal Monday-Thursday and 2 pm dismissal on Friday Cost: $1,080.00 for the year Option 2: Morning only * Pick up to arrive at school 8:25am Monday-Friday Cost $720.00 for the year Option 3: Afternoon only * Pick up from school at 4pm or 5pm dismissal Monday-Thursday and 2pm Friday Cost $720.00 for the year Option 4: Mishmar only * 5:30pm pick up from school on days that there is Mishmar for 5th and 6th grade boys Please Note: 1) If you have already paid for option 1 or 3 this is included. 2) In the event that there is no Mishmar no bus will be provided for 5th and 6th grade boys who choose this option. Cost $150.00 for the year Name Grade Select Option Below Amount Total: Your place on the bus will not be reserved until we have received these papers and payment. Signed papers and payment can be mailed to Yeshiva Elementary School, 7902 Carlyle Ave, Miami Beach FL 33141, delivered to the main office, faxed to 305-867-3388 or emailed to wendytokayer@yeshivaelementary.com. Any copy of this agreement sent via facsimile or email shall be deemed to be a valid form of delivery. Page 5 of 5