| g|ve my perm|ss|on for my ch||d to part|c|pate |n "The Progress|ve 0|nner" w|th Crace 6ommun|ty 6hurch on 0ecember 17th 2011. Tre urders|gred rereoy corserls lo & aulror|ze r|ror cr||d rared oe|oW lo parl|c|pale |r The Progress|ve 0|nner corducled oy Crace 6ommun|ty 6hurch ('Crurcr). we lurlrer aulror|ze r|ror cr||d lo lrave| W|lr represerlal|ves ol lre Crurcr |r pr|vale or crurcr ver|c|es. ll a parerl, lar||y prys|c|ar, or derl|sl carrol oe corlacled prorpl|y, ard a red|ca| or derla| erergercy ras oeer delerr|red lo ex|sl, lre urders|gred parerl or guard|ar ol lre r|ror cr||d rared aoove rereoy aulror|zes ary represerlal|ves ol lre Crurcr lor ard or oera|l ol lre urders|gred, lo corserl lo ary x-ray, areslrel|c, red|ca|, surg|ca| or derla| d|agros|s ol lrealrerl ard ary rosp|la| care deered adv|sao|e ard rerdered oy ary ||cersed prys|c|ar, or surgeor, EVT, rurse, or derl|sl, Wrelrer |r r|s/rer oll|ce or |r ary ||cersed rosp|la| or rea|lr care lac|||ly. Tr|s aulror|zal|or |s g|ver |r advarce ol ary sucr requ|red care lor purposes ol erpoWer|rg ary sucr represerlal|ve or oll|c|a| ol lre Crurcr lo g|ve lre aoove descr|oed corserl lor ary sucr red|ca|, or derla|, as re/sre ray deer adv|sao|e. we reroy agree lo pay ary ard a|| reasorao|e crarges |rcurred as a resu|l ol ary sucr red|ca| or derla| lrealrerl ard lo ro|d lre Crurcr ard |l's represerlal|ves ard oll|c|a|s rarr|ess. Tre urders|gred rereoy re|ease lre Crurcr ard |ls aulror|zed represerlal|ves ard oll|c|a|s ol ard lror ary ard a|| ||ao|||ly lo lre urders|gred, or lour r|ror cr||d, ar|s|rg oul ol or |r correcl|or W|lr acl|v|l|es re|aled lo lre Crurcr, or ary lrave| correcled lrereW|lr, excepl lor sucr ||ao|||ly as ray ar|se lror lre gross reg||gerce or W|||lu| r|scorducl or lre parl ol lre Crurcr or |ls represerlal|ves or oll|c|a|s. To lre exlerl lral ary app||cao|e |aW preverls or pror|o|ls lre urders|grers' re|ease ol lre Crurcr lror ary ||ao|||ly lo our r|ror cr||d as sel lorlr rere|r, We rereoy agree lo |rderr|ly ard ro|d rarr|ess lre Crurcr ard |ls represerlal|ves ard oll|c|a|s ol ard lror ary sucr ||ao|||ly as ray oe |rposed upor ary ol lrer.