AUTHORIZATION: I/We hereby authorize LCRC Family Centers Inc., and Our Lady of Santa Clara Retreat Center, LLC to use the image and likeness of me/us or my/our child in photograph or video form whether taken by or commissioned by them. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our or my/our child’s image and likeness on the website of Our Lady of Santa Clara Retreat Center LLC., or its successor in operation or affiliated organization(s) upon written consent of Our Lady of Santa Clara Retreat Center LLC, I/We understand that this authorization shall survive the end of my/our or my/our child’s participation in the activities referenced on this form.

RELEASE AND INDEMNIFICATION: I/We release and waive, and further agree to indemnify, hold harmless or reimburse LCRC Family Centers Inc., and Our Lady of Santa Clara Retreat Center LLC the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by LCRC Family Centers Inc., and Our Lady of Santa Clara Retreat Center LLC., or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of participation in the activities referenced on this form and shall have no limitation in time or amount.