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Kings Canyon SD |  E  5141  Students

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Hold Harmless Clause

The custodial parents or guardians signed below hold Kings Canyon Unified School District and its agents harmless in the districts attempting to follow the instructions of the DNAR.

The undersigned, as the parents/legal guardians of _____________________, hereby indemnify, defend and hold harmless the Kings Canyon Unified School District and any of its agents, officers, employees and elected officials from any and all liability, claims, demands and/or causes of action for any costs or damages whatsoever arising out of the District's conduct related to this request to forego resuscitative measures.

__________________________________________ ___________________________

Signature of Parent/Legal Guardian Date

__________________________________________ ___________________________

Signature of Parent/Legal Guardian Date

Exhibit KINGS CANYON JOINT UNIFIED SCHOOL DISTRICT

version: May 21, 2001 Reedley, California