Parental Consent Form

I / we, being the parent or legal guardian of the child named above (the "child"), do hereby consent to the participation of our child in the activities of Rise Youth Camp , 7/5 - 7/8. Old Oak Ranch 15250 Old Oak Ranch Rd. Sonora, CA 95370 (209)532-4295

ON CAMPUS ACTIVITIES including, but not limited to: Activities including, but not limited to, Ultimate Frisbee, Basketball, Volley Ball, Dodge Ball, Tug-of-war, football, Swimming, Hiking, Climbing, canoeing, paddle boating, kayaking, and inner- tubing in which participants may be subject to bites from insects, ticks, mosquitoes, spiders, and / or snakes. OFF CAMPUS ACTIVITES: traveling from Jesus Culture Sacramento to Old Oak Ranch.

I / we hereby represent that child is in good health and in proper physical condition to participate in the above activities. Further, I / we certify that my child is physically able and adequately trained to participate in such events, including swimming. I / we understand and acknowledge the physical rigors associated with the activities and understand that participation involves risks and dangers which include, without limitation, the potential for serious bodily injury, permanent disability, paralysis and death; inaccessibility of medical care; dangers arising from adverse weather conditions; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of JCS; and other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers ("Risks"). I / we understand that these Risks may be caused in whole or in part by child’s own actions or inactions, the actions or inactions of others participating in the activity, and I / we hereby expressly authorize our child to participate in the above activities.