Transportation: For each week selected above, I give my permission for my child


(name) to be transported to camp activities in the Cape Girardeau area. In addition, my child has my permission to be transported for the field trip on Friday(s). The mode of transportation will be the Graceful Opportunities van driven by a member of the Grace Reliant Health Services staff. All persons transported for camp activities by camp staff are deemed to have waived all claims against Grace Reliant Health Services and Graceful Opportunities and their representatives for injury, accidents, illness or death occurring during or by reason of the activities.

Medical: Should it be necessary for my child to have emergency medical treatment while at the Career Exploration Camp or enroute to one of its activities/destinations, I give the camp staff

permission to use their judgment in obtaining medical services. Permission is given to the doctor(s) to render necessary treatment. I understand that payment for any medical services provided is my responsibility.

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By signing this form, I consent for my child to attend the Career Exploration Camp for the dates initialed above. I also give my permission for my child to be transported during the weeks selected for camp activities in the Graceful Opportunities van driven by a member of the GRHS staff. I further agree that the camp staff have my permission to obtain any emergency medical services needed at my expense and that I will hold Graceful Opportunities, Grace Reliant Health Services and their representatives harmless from any liability.