I hereby give my child/student (listed above) permission to participate in the Calvary Chapel of Olympia High School Youth Group activities from June 1, 2022 through August 31, 2023. I understand that the activities, as well as transportation to, during, and from the activities, present a risk of personal injury. In consideration of Calvary Chapel allowing my child to participate in the activities, I hereby release and agree to hold harmless Calvary Chapel, together with its agents and employees, from all liability, actions, causes of action, damages, claims or demands which I, or my heirs, administrators or assigns may have against Calvary Chapel (including its agents and employees) for all personal injuries, loss, or damage, known or unknown, which I or my child may incur as a result of participating in this year's activities.

I, the undersigned, have read this release and understand all its terms. I and my child are aware of the risks presented by the activities, and are voluntarily approving and participating in the activities, and do voluntarily assume the risk of any loss, damage, or injury that may occur as a result of participation in the activity.

I, being the parent and/or legal guardian of the child/student listed above do appoint, any agent of Calvary Chapel, as my attorney-in-fact, in my name, place and stead, to (1) administer first aid to said child without liability, and (2) to admit said child to any hospital or clinic, and to authorize any medical treatment, including surgery, in the event of emergency illness, as said agent of Calvary may deem appropriate. I understand that, in the event it appears that medical treatment is required, every reasonable effort will be made to contact me first.

Any hospital, clinic or doctor may rely on a telephonic communication reasonably believed to be from the undersigned or an agent of Calvary Chapel.

I fully agree to assume full financial responsibility for any and all charges incurred, specifically including ambulance, doctor, hospital or medication.

I further promise to hold harmless Calvary Chapel and/or its employees and agents from any and all expense incurred pursuant to this authorization in obtaining medical treatment and/or transfer, including but not limited to: ambulance expense, cost of paramedics, hospital expense, and/or physician charges.

The following information requested is needed by any hospital or practitioner not having access to the child's medical history. Please put "N/A" where not applicable.

I (we) the legal parent/guardian of the student listed above, have executed this permission, release and authorization by filling out the information below.

In the event of an injury to the child attendee, it is the policy of the church that the individual's insurance be primary and that any Calvary Chapel medical coverage which may exist be secondary.