I, the parent or legal guardian of the Camper identified below, give my permission for the Camper to participate in the Weekend Camp (the "Activity"), which may include various outdoor activities, including, but not limited to, camping, hiking, campfires, archery, and swimming.

I understand that participating in the Activity is a potentially hazardous activity that involves a risk of personal or bodily injury and even death. I agree that the Camper is voluntarily participating in the Activity and doing so with my consent. As consideration for the Camper being permitted to participate in the Activity, Camper and I ASSUME ALL RISK OF INJURY, ILLNESS, DEATH, DAMAGES OR LOSS TO CAMPER OR CAMPER’S PROPERTY THAT MIGHT RESULT, INCLUDING, WITHOUT LIMITATION, ANY LOSS OR THEFT OF ANY PERSONAL PROPERTY.

Camper and I agree on behalf of ourselves, and each of our personal representatives, heirs, executors, administrators, agents, and assigns to RELEASE AND DISCHARGE Homenetmen Los Angeles Chapter ("HLAC") and its Board members, officers, employees, volunteers, representatives, and all other agents (collectively, "HLAC's Agents") from any and all costs, losses, demands, suits, action, payments, judgments, claims or causes of action (known or unknown), including legal and attorney fees arising out of or relating to my participation in the Activity.

In case of an emergency, I understand that a reasonable effort will be made to contact me. In the event that I cannot be reasonably reached, I hereby give permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for the camper. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up, and communication with the camper's parents or guardian, and/or determination of the camper's ability to continue in the program activities.

HLAC may capture photographs and/or video or audio recordings (“Recordings”) of CAMPER in connection with the Activity. I grant to HLAC an irrevocable, perpetual, worldwide, royalty-free license to use my name, voice, likeness, biographical information, and other indicia of my identity as they appear in the Recordings and publicly use, display, reproduce, publish, distribute, modify, transmit and otherwise exploit, in whole or in part, such Recordings in any language and in all formats or media existing now or later discovered.

I) acknowledge that I  have carefully read this Waiver and fully understand that it is a release of liability. I UNDERSTAND THAT I AM WAIVING ANY RIGHT THAT CAMPER OR I MAY HAVE TO BRING A LEGAL ACTION TO ASSERT A CLAIM AGAINST HLAC OR HLAC's AGENTS RELATING TO CAMPER’S PARTICIPATION IN THE ACTIVITY. I hereby give my express consent to the execution thereof and will not revoke my consent. Typing my name below serves as an electronic signature and indicates my agreement to the terms stated herein.