2023 TIOH Religious School L’taken Trip to Washington DC 9th and 10th Grade February 24-27, 2023 HiddenAdmin Coupon Code Parent 1 Name(Required) First Last Parent 1 Email(Required) Parent 1 Cell Phone(Required)Parent 2 Name First Last Parent 2 Email Parent 2 Cell PhoneTeen Name(Required) First Last Teen Email(Required) Teen Cell Phone(Required)Allergies(Required)If no allergies, please write "No allergies" in the box below.Liability Waiver(Required)I consent to my child(ren) participating in this Activity and assume all risks involved with their full and unrestricted participation. I acknowledge that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others and in consideration of the risk of injury while participating in the Activity, and as consideration for the right to participate in the Activity, I hereby, for myself, family, 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, except acts of negligence of any kind, arising out of my child(ren) participating in the Activity, and do hereby release and forever discharge TIOH, located at 7300 Hollywood Blvd, Los Angeles, California 90046, 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 my child(ren) or I may suffer as a direct result of their participation in the aforementioned Activity, including traveling to and from this Activity or an event related to this Activity. I agree to indemnify and hold harmless TIOH 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 or my child(ren)’s behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or be anyone else acting on my or my child(ren)’s behalf. If TIOH incurs any of these types of expenses, I agree to reimburse TIOH, including errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of TIOH. In the event of a medical emergency, any adult accompanying my child on the Activity may consent to the administration of medical or dental care to my child as deemed appropriate. In the event that my child(ren) should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I acknowledge that I have carefully read this "waiver and release" and fully understand that it is a release of liability. On behalf of my child(ren) and myself I expressly agree to release and discharge TIOH 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 we agree to voluntarily give up or waive any right that I or my child(ren) might otherwise have to bring a legal action against TIOH for personal injury or property damage. In the event that any damage to equipment or facilities occurs as a result of my or my family’s actions, I acknowledge and agree to be held liable for any and all costs associated with those actions. 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 Release of Liability 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. I represent and warrant that I am the legal guardian of the child(ren) listed about and have full power and authority to execute this release on their and my own behalf. I agree to the above waiver of liability.Flight Information You are responsible for purchasing your own plane ticket. Please purchase the following flights for your teen and forward the confirmation email to Liana (lwertman@tioh.org). Please choose a seat in Economy and we will rearrange the seats to be all together when we receive confirmation emails: Friday February 24 LAX-DCA Delta Flight #DL380 Departs LAX: 7:50am Arrives DCA: 3:55pm Monday February 27 DCA-LAX Delta Flight #DL380 Departs DCA 5:05pm Arrives LAX 7:51pm More registration will come as soon as we receive this initial registration form.Trip Cost Amount: Discounts Credit Card Fees $0.00 Total Charge Add Credit Card Fees Please increase my total by 3% to cover credit card fees for TIOH Billing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Home