Fr6§rettire 0iaaer 0etzilt

0zy! $zt0r6zy, 0etember 1I
th

flNI! Neet zt 6rzte 6h0rth zt 5pm, ret0ra t6 6rzte zt 9pm
66tt! I5 t6 t6rer §zt|l666
K6v t6 ti§a 0p ! f0ra ia the bel6v me6itzl relezte za6 y60r I5 t6 t6alirm
y60r tp6t.

Fzreatzl 66ateat, Ne6itzl A0th6rizzti6a â kelezte


| 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.

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