NEWBOY

Emergency Youth Information Sheet

Emergency Contact: In the event that the primary guardian cannot be reached:

Medical facts requiring special attention (Medications, Sleep issues, etc)

IBNB Mentoring & Youth Development Program

2022 IBNB/IMN California Dreamin' College & Historical Tour Child Care Authorization and Permission Form and Release of Liability July 20, 2022-July 24, 2022

(Parent's name). the parents or guardians of the below described minor(s), and legally entitled to give this authoriza- tion, grant the Inner Beauty Program, Inc. /New B.O.Y. Inc, Indy Mentor Net- work, Staff, Mentors/Sponsors temporary authority, limited to the below de- fined power, over the following child:

The powers granted to above said Life coaches, Mentors and Sponsors are limited to the following. *To seek medical care for the youth, including, but not limited to, visits to the doctor, and/or hospital. *To authorize medical treatment or medical procedures in the event of an emergency situation. *To provide food and shelter for the above named youth, and to make decisions regarding their safety on the trip. *To transport children on chartered bus transportation. I/we understand that reasonable precaution will be taken to safeguard my child's physical, emotional, and social and mental wellbeing during this Transformational travel experience to Los Angeles, CA. The group will be traveling by plane on Wednesday, July 20, 2022 from the Indianapolis Intl Airport and will return on Sunday, July 24, 2022. If you have any questions pertaining to the trip: please call Kareem Hines at 317-869-5022 or Chrystal Hines at 317-833-5810.

(Youth Name) Los Angeles, CA for the College & Historical Tour 2022.

to participate in the IBNB trip to

I/we release and forever discharge and hold harmless Inner Beauty Program, Inc., New B.O.Y., Indy Mentor Network, Philly Mentor Network, The Indiana Department of Child Services, Marion County Juvenile Probation, Mentors, trip chaperones, and any trip sponsors and/or collaborators, (collectively, the "Released Parties") from any and all liability, claims, and demands of any nature, either in law or in equity, which have arisen or may hereafter arise from the above-named Youth's participation in this men- toring trip. I understand and acknowledge that this Child Care Authorization and Per- mission Form and Release of Liability (the "Agreement") discharges the Released Par- ties from any liability or claim that I/we or the above-named Youth may have against the Released Parties with respect to bodily injury, personal injury, illness, death, or property damages that may result from the above-named Youth's participation in this mentoring trip.

IBNB Mentoring & Youth Development Program

I/we acknowledge that novel coronavirus ("COVID-19") infections have been confirmed throughout the United States. In accordance with the guidance and protocols issued by health and governmental agencies, I hereby agree, represent, and warrant that the above-named Youth will not attend this mentoring trip if (i) the above-named Youth is exposed to any person with a confirmed case of COVID-19 within fourteen (14) days of the mentoring trip; (ii) the above-named Youth experiences symptoms of COVID-19 within five (5) days of the mentoring trip; or (iii) the above-named Youth tests positive for COVID-19 within five (5) days of the mentoring trip. I/we further acknowledge and agree that, due to the nature of the mentoring trip, social distancing of six (6) feet per person will not be possible. I/we fully understand and appreciate both the known and potential dangers of the above-named Youth's participation in the mentoring trip and acknowledge that such participation may result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death. 1/ WE HEREBY RELEASE, WAIVE, AND DISCHARGE the Released Parties from all liability to me/ us and the above-named Youth and all personal representatives, assigns, heirs, and next of kin of ours for any loss or damage, and any claim or demands on account of any property damage or any injury to, or an illness or my/our death (or any person who may contract COVID-19, directly or indirectly, from the above-named Youth's participation in the mentoring trip), whether caused by the Released Parties or otherwise, during the mentoring trip. I/we understand and acknowledge that the Released Parties do not assume any responsibility for or obligation to provide the above-named Youth with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I/we expressly waive any such claim for compensation or liability on the part of the Released Parties beyond what may be of- fered freely by the Released Parties in the event of injury to or medical expenses in- curred by the above-named Youth on the mentoring trip. This grant of authority is effective as of 7/20/22, and shall remain in effect until the group returns to Indianapolis, IN on 7/24/22. All releases and waivers contained in this Agreement shall survive the termination of the grant of authority. I/we agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Indiana and that this Release shall be governed by and in- terpreted in accordance with the laws of the State of Indiana. I/we agree that in the event that any clause or provision of this Agreement is deemed invalid, the enforce- ability of the remaining provisions of this Release shall not be affected.