Release, Waiver, and Indemnity Agreement

9-5B

RELEASE, WAIVER, AND INDEMNITY AGREEMENT

I certify that I have been informed that, while attending NewBethelChurch during the year _____, I/my child/children will participate in activities which carry a certain degree of risk. Activities include outdoor games, swimming, ice skating, rafting, camping, sports, festivals, as well as other activities. I consent for myself /my child/children to participate in these activities. I also represent that I/ my child/children is physically fit and has the necessary skills to safely participate in these activities. Particularly, I state that I/my child/children can swim. I also give permission for myself/my child/children to attend NewBethelChurch activities both at and away from the church.

IT IS THE INTENTION OF ______(PARENT OR GUARDIAN OF MINOR) BY THIS AGREEMENT TO EXEMPT AND RELIEVE NEW BETHEL CHURCH, INC., AND ITS OFFICERS, AGENTS,SERVANTS, OR EMPLOYEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTYDAMAGE, OR WRONGFUL DEATH OF ______(NAME OF MINOR, herein known as “MINOR”) CAUSED BY ANY ACT OF NEGLIGENCE OF NEW BETHEL CHURCH, INC., AND ITS OFFICERS, AGENTS, SERVANTS,OR EMPLOYEES.For and in consideration of permitting MINOR to observe, or use any facility or equipment of NEW BETHEL CHURCH, INC., or engage in and/or receive instruction in any activity or activityincidental thereto SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILYINJURY at: NEW BETHEL CHURCH, INC., in the city of LEXINGTON, County of JEFFERSON,and State of INDIANA, for the year of ______, the undersigned parent and/orguardian of MINOR: hereby voluntarily and absolutely releases, discharges, waives, and relinquishes any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death occurring to MINOR as a result of MINOR'S observing or using facilities or equipment of NEW BETHEL CHURCH, INC., or engaging in or receiving instructions in any activities SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY INJURY or in activities incidental thereto wherever or however the same may occur, and for whatever period said activities or instructions may continue.The undersigned parent or guardian of MINOR for him/herself, his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, orwrongful death shall be prosecuted against NEW BETHEL CHURCH, INC., or its officers, agents,servants, or employees, the undersigned parent or guardian will indemnify and hold harmlessNEW BETHEL CHURCH, INC. and its officers, agents, servants, or employees from any and allclaims or causes of action by MINOR or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the undersigned parent or guardian of MINOR present any claim against NEW BETHEL CHURCH, INC., and said persons for personal injuries, property damage, wrongful death, or otherwise, caused by any act of negligence by NEW BETHEL CHURCH, INC., and said persons.The undersigned parent or guardian represent that he/she has read this Release, has requested andhas been provided with, or has requested and declined advisement on the potential dangers/risks ofengaging in the observation, activities, or instruction offered, assumes all risks associated with suchdangers and risks, and is fully aware of and understands the terms and the legal consequences of thesigning of this Release. The undersigned parent or legal guardian intends his or her signature to be acomplete and unconditional release of all liability to the greatest extent allowed by law and if any portionof the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legalforce and effect.

DATED: ______

SIGNATURE OF PARENT/GUARDIAN FOR MINOR: ______