LIMITED Waiver of Liability and Disclosure

Parent's Name

Child's Name

LIMITED WAIVER OF LIABILITY AND DISCLOSURE The undersigned parents (referred to hereinafter as “Participant”), on behalf of Participant and the undersigned, acknowledge, confirm and agree to the following terms and conditions in connection with participation by Participant in the KESHET BOYS DAY & TRAVEL CAMP LLC (the “Program”) occurring at Ohr Simcha congregation, 12436 Oxnard St., North Hollywood, California 91606 (“Ohr Simcha”) during the summer of 2011 (the “Program Session”): 1. During the Program Session, a number of the parents of children who will be participating in the Program (the “Program Parents”) will be volunteering their services and/or facilities, from time to time, to the Program, in various capacities, such as providing transportation to and from authorized events of the Program, hosting children and the Program at their homes for such things as swimming sessions and engaging in other Program authorized activities with children participating in the Program (such services and facilities, as requested and authorized by the Program, which are provided by the Program Parents from time to time are collectively referred to as the “Parental Services”). 2. The undersigned agrees that it will have and maintain at all times during the Program Session, and for six (6) months thereafter, an adequate and appropriate amount of occurrence based home owners, automotive and personal injury/medical liability insurance covering Participant and any of the services and/or facilities provide by the undersigned (or the spouse or other family members of the undersigned) as a Program Parent. Furthermore, the undersigned agrees that, except with respect to any grossly negligent, intentional or reckless act or omission (collectively, the “Grossly Reckless Acts”) by the Program Parents, “Ohr Simcha Personnel” (as defined herein) and/or Ohr Simcha, in the event that Participant is injured in the Program during the performance of Parental Services or otherwise, the undersigned shall: (i) first utilize its own personal liability and/or medical insurance to cover any and all costs and/or medical expenses associated with said injury; (ii) not seek reimbursement for any such costs and/or medical expenses resulting from such injury from (x) the Program Parents, or (y) the staff and/or employees of the Program or any of the officers, directors or employees of Ohr Simcha (collectively, the “Ohr Simcha Personnel”); and (iii) unless the undersigned’s personal liability and/or medical insurance does not cover such costs and expenses with respect to such injury, seek reimbursement from Ohr Simcha only to the extent of the maximum limitations of the general commercial liability and any other applicable insurance policies for (or held by) Ohr Simcha or the Program covering the Program. 3. The undersigned, on behalf of himself/herself and the Participant, hereby releases and forever discharges the Program Parents and the Ohr Simcha Personnel from any and all actions, cause of actions, suits, damages, judgments, claims and demands whatsoever in law or in equity, whether known or unknown, which the undersigned now has or may or might in the future have against the Program Parents, Ohr Simcha Personnel, or any of them, solely with respect to any injury or death of Participant which may be or is as a result of said Program Parents providing Parental Services during the Program Session, or as a result of Ohr Simcha Personnel providing services in connection with the Program, except with respect to: (i) Grossly Reckless Acts by the Program Parents, or Ohr Simcha Personnel; or (ii) only the extent of the maximum limitations of any applicable insurance coverage which the Program Parents may have to cover injury and/or death due to a negligent act or omission by said Program Parents in their performance of Parental Services. 4. This limited waiver of liability and disclosure is executed with the full knowledge and understanding on the part of the undersigned and the undersigned hereby certifies that he/she has read all of this limited waiver of liability and disclosure, or had it read to him/her, that he/she has had an opportunity to discuss it with his/her attorney, that he/she fully understands same and that he/she has executed it voluntarily. The foregoing limited waiver of liability and disclosure agreement is to be governed by the laws of the State of California and if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect as may be permitted under California law. IN WITNESS WHEREOF, each of the undersigned have executed this limited waiver of liability and disclosure, effective as of this 20th day of June, 2011

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