*Yes

*As the parent/guardian of the above child/ren, I authorize any staff member of person acting on behalf of Aleph-Bet Village to administer first aid, hospitalize or secure treatment for my child. Aleph-Bet Village will make every effort to reach a parent/ legal guardian, and will use the authorization of this form when time and circumstance doesn’t allow for waiting to contact a parent. I agree to pay all charges associated with care and/or treatment.

*I grant permission to Aleph-Bet Village, its employees and representatives to use images of my child taken in conjunction with Aleph-Bet Village for publications such as electronic material, newsletters, social media outlets, and advertising.