Statement of Authorization

1. My child has permission to participate in all program activities and related field trips.

2. My child has permission to participate in swimming activities.

3. In the case that your child becomes ill during the program, you will be contacted as soon as possible. If the parent or guardian

is unable to be reached, the child's emergency contact will be notified. It is the responsibility of the parents or guardians to

arrange for the child to be picked up from the camp as soon as possible.

4. My signature authorizes the staff of the Russian camp to act for me according to their best judgment in the event of a medical emergency and/or routine medical care. I/we grant permission for emergency medical treatment and/or routine medical care, a rescue squad, or private physician and/or hospital or emergency health care facility staff, under the same circumstances as above, if needed. Any such action will be taken in the best interest of my child and will be reported to me/us as soon as possible. My signature waives and/or releases the staff from any and all liability and/or financial responsibility for any medical expenses incurred.

6. The parent/guardian authorizes the application of sunscreen for his or her child.

7. The parent/guardian authorizes the application of insect repellent for his or her child.

hereby grant my permission to "Living Cultures" to take pictures, films, slides, audiotapes, videotapes and other related audiovisual materials of my child/children,

Photograph & Video Release Form

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration.

Photographic, audio or video recordings may be used for the following purposes:

• informational presentations with no children's names mentioned
• educational videos

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

I hereby release any and all claims against "Living Cultures" utilizing this material for educational purposes.