I do hereby authorize Calvary Episcopal Church and its leaders as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act whether such diagnosis or treatment is rendered at the off if said physician or at the hospital.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of their best judgment may deem advisable.

This authorization shall remain effective until the parent(s) have indicated otherwise in writing to said agent(s).

I shall indemnify, hold free and harmless, assume liability for, and defend Calvary Episcopal Church, its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, attorneys’ fees, reasonable investigative and discovery costs, court costs, and all sums which Calvary Episcopal Church, its agents, servants, employees, officers, and directors may pay or become obligated to pay on account of any, all and every demand for, claim or assertion of liability, or any claims or action founded thereon, arising or alleged to arisen out of my child’s use of real personal property belonging to Calvary Episcopal Church, its agents, servants, employees, officers, and directors, or by any action or omission by my child.

General Release:
I hereby grant permission for my child to engage in the various activities sponsored by Calvary Episcopal Church for its youth programs. This permission includes, but is not limited to, travel in automobiles, attendance at related group activities, and general participation in any and all activities sponsored by or associated with Calvary.

Photo Release:
I hereby grant to Calvary Episcopal Church, and its representatives, permission to use photographs of my child in Calvary’s publications, press releases, on its website and through any other media that publicizes or promotes Calvary and I release the photographer, Calvary and their legal representatives from all claims relating to said photographs.

Waiver:
I understand that a participant who does not abide by the rules of Calvary Episcopal Church may be dismissed from the youth group or activity. Signature of participant and parent/guardian on this form waives and releases all volunteers from liability due to injury or illness incurred during activities or traveling to and from destinations. Participants are responsible for their own property. Calvary Episcopal Church and the volunteers are not responsible.

By typing your name below, you consent to the above.