Bnei Baruch Association
112 Zabotinski St.
Petah Tikva, Israel
49513
P.O.B. 3228

Re: Letter of Parental Consent letter for a Minor for the participation in the Kabbalah Congress 2010 in Israel

The undersigned ___________________, passport number_______
And ___________________, passport number_______
Address____________________________________________________
Phone number_____________
As the parent/guardian of ________________, passport number________
and of ________________, passport number________
and of ________________, passport number________ hereby consent for the participation of my child in all the activities of the “Opening The Zohar - Birth of a New Reality” Kabbalah Congress 2010 hosted by Bnei Baruch Kabbalah Education & Research Institute, an organization which works on the dissemination of the wisdom of Kabbalah.

I am aware that my child will be filmed and may participate in television shows, radio shows, advertisement etc.

I hereby grant Bnei Baruch the irrevocable right and permission, throughout the world, in connection with the photograph(s)/video(s)/quotation(s) that are taken of me at the Bnei Baruch Kabbalah Congress to use all such recorded media. I agree that Bnei Baruch may use such photograph(s)/video(s)/quotation(s) of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I agree that these photograph(s)/video(s)/quotation(s) are taken without financial remuneration, and I hereby hold harmless and release and forever discharge Bnei Baruch from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Date	Signature [father]	Signature [mother]

I hereby declare that I have signed this document after reading it carefully and understanding its content, meaning and judicial consequences.