We, as the undersigned parents and natural guardians of , do hereby give our consent to our son’s circumcision under the direction and supervision of Rabbi Michael Rovinsky, and have agreed individually and on behalf of our child, to the terms of the Waiver and Release of Liability Agreement set forth below.

Through this Waiver and Release of Liability Agreement, we particularly manifest that:

1. We are the ones who engaged Rabbi Rovinsky’s services as we believe that he is adequately capable of performing the circumcision upon our child;
2. We are aware that he is not medically licensed, but we still prefer to utilize his services as he is Rabbinically trained to do the circumcision;
3. We understand and acknowledge that Rabbi Michael Rovinsky is only a tenant leasing space in the subject facility and is not otherwise associated with Tiferet Israel Congregation and Tiferet Israel Congregation is not a party to or involved with the provision of any services or procedures provided by Rabbi Michael Rovinsky.
4. We assume all the risks that may arise as a result of our child’s participation in the circumcision performed by Rabbi Michael Rovinsky, including but not limited to, risks that may arise from unforeseen complications as a result thereof;
5. We hereby waive our right to sue Rabbi Michael Rovinsky and Tiferet Israel Congregation in the event that any unforeseen complications do arise or occur, and instead hereby consent to settle the same by way of indemnity;
6. We agree to exclude this circumcision activity performed upon our child from the jurisdiction of the United States Medical Board and any similar or related entities in the national, state or local level, as it is our belief that this is a holistic undertaking.
7. Furthermore, we certify that our son is physically fit, and is sufficiently prepared to undergo circumcision. Moreover, we aver that there are no health-related reasons or problems that preclude our son’s participation in this activity.

We acknowledge that this Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

WE AGREE TO SAVE AND HOLD HARMLESS, RELEASE AND INDEMNIFY RABBI MICHAEL ROVINSKYAND TIFERET ISRAEL CONGREGATION, ITS OFFICERS, DIRECTORS, AND EMPLOYEES (COLLECTIVELY, THE "INDEMNITEES"), FROM AND AGAINST ANY AND ALL DAMAGES, LOSSES, COSTS, EXPENSES (INCLUDING REASONABLE LEGAL COSTS, EXPENSES AND ATTORNEYS' FEES) AND LIABILITIES INCIDENT TO ANY CLAIMS, DEMANDS OR CAUSES OF ACTION WHATSOEVER, INCLUDING WITHOUT LIMITATION THOSE ARISING ON ACCOUNT OF ANY INJURY OR DEATH OF PERSONS OR DAMAGE TO PROPERTY CAUSED BY, OR ARISING OUT OF, OR RESULTING FROM, THE PERFORMANCE OF THE SERVICES MADE THE SUBJECT OF THIS AGREEMENT AND INDEMNITEES OPERATION OF THE PREMISES WHICH MAY BE BROUGHT BY OR ON BEHALF OF ANY PERSON OR ENTITY EVEN THOUGH CAUSED IN WHOLE OR IN PART BY A PRE-EXISTING DEFECT, THE NEGLIGENCE (WHETHER SOLE, JOINT OR CONCURRENT), GROSS NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL FAULT OF RABBI MICHAEL ROVINSKY AND / OR ANY OF THE INDEMNITEES. THIS SAVE AND HOLD HARMLESS, RELEASE AND INDEMNITY INCLUDES ANY AND ALL LIABILITY, LOSSES, CAUSES OF ACTION, COSTS, CLAIMS, OR DAMAGES WHATSOEVER WHICH MAY BE IMPOSED UPON RABBI MICHAEL ROVINSKY AND / OR ANY OF THE INDEMNITEES BECAUSE OF ANY DEFECT IN OR LACK OF SUCH CAPACITY TO SO ACT AND WE RELEASE SAID PARTIES ON BEHALF OF OURSELVES, INDIVIDUALLY, AND ON BEHALF OF OUR CHILD.

FINALLY, WE CERTIFY THAT WE HAVE READ THIS DOCUMENT, AND WE FULLY UNDERSTAND ITS CONTENT. WE ARE AWARE THAT THIS IS A RELEASE OF LIABILITY CONTRACT AND WE SIGN IT OF OUR OWN FREE WILL.

Please make sure at least one parent signs the waiver.