Leadership Training Liability Waiver, Release, and Agreement to Hold Harmless

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First Name *

Last Name *

Contact Phone Number *

Contact Email *

Emergency Contact Name *

Emergency Contact Phone Number *

Leadership Training Program "The Program" Location *

Estes Park

Winter Park

Adirondack

I hereby declare that I am the participant named below (the "Participant"), or if younger than 18 years of age, am the parent or legal guardian of the minor named below, and as such, I hereby give my full consent and approval for Participant to participate in the Leadership Training Program "The Program" (location listed above) sponsored by Reliant Mission ("Reliant") and Collegiate Church Network ("Collegiate"). *

Yes

Program Participation- Hold Harmless and Release

I recognize and fully understand that for any and all events and activities in which Participant participates through the Program, including but not limited to those events and activities as have been described to me and other related activities, there is the possibility of injury to person and/or property due to participation in the Program and related activities.

I expressly agree to and do hereby accept and assume all of the risks existing in and in any way associated with such activity and/or with the Program, be they known or unknown risks. I declare that my willing participation in the Program is purely voluntary, and I elect to participate in the Program in spite of and with full knowledge and understanding of the inherent risks.

As consideration and as a condition for allowing Participant to participate in the Program, I hereby voluntarily for myself, my heirs, assigns, executors, administrators, and personal representatives, forever release, discharge, and agree to indemnify and hold harmless Reliant, Collegiate and their respective employees, directors, officers, agents, and volunteers from and against any and all claims, demands, actions, or causes of action of any kind (including but not limited to claims due to personal injury, death, or property damage, or claims alleging negligent acts or omissions of Reliant or its employees, directors, officers, agents, and volunteers) which may arise out of, result from, or in any way be connected with Participant's participation in the Program or use of Reliant, Collegiate or Program equipment or facilities.

I further agree to forever indemnify and hold harmless Reliant, Collegiate, the Program, or anyway acting on the behalf of either, or any and all attorney's fees or other costs incurred as a result of defending or enforcing this agreement.

Release: I further acknowledge and fully understand that by signing this document I have agreed to release Reliant, Collegiate, the Program, and all other related parties identified herein from any and all present or future claims or lawsuits of any kind arising out of or resulting from Participant's participation in the Program. I have had sufficient opportunity to read this entire document, consult with legal counsel of my choosing if so desired, and further that I have read and understood this agreement, and I agree to be bound by its terms.

By submitting this completed form you are agreeing to the statements above.

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