Pastor's Full Name *

First Name

Last Name

Phone

(###)

###

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Church Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Liability Waiver *

Please read carefully before signing: (Legal Stuff) You are required to digitally sign this waiver to be allowed to participate. RELEASE OF LIABILITY AND WAIVER Corporations (both profit and non-profit), individuals, both minor and parent/guardians of minors, understand and agree that an invitation to participate in activities is being extended to said individuals/entities and the invitation should not be considered an organized function of any organization or entity. In consideration of being permitted to use the property, equipment, and/or facilities owned, leased to, or operated by REAL MOMENTUM, its/their officers, friends, agents, employees, members, owners, and/or lessors, hereinafter individually and collectively referred to as “Releasee”, for the purpose of the following activities: hunting, fishing, camping, lodging, ATV, or any other motorized vehicle, whether such activity engages equipment leased from the Releasee or owned by the participant, said participant, his/her personal representatives, assigns, heirs, and next of kin hereinafter referred to individually and collectively as “Releasor”, hereby releases, waives, discharges, and covenants to hold harmless the Releasee from all liability to the Releasor, for any or all loss or damage on account of injury to the person or property of, or resulting in the death of the Releasor(s), whether directly or in a peripheral activity, or for mere presence on the property of Releasee, said property having been heretofore described. Releasor further releases all volunteers, officials, and professional personnel from any claim on account of the rendering of first aid, medical treatment or services. Releasor(s) acknowledges that such previously described activities are inherently dangerous and that participation in such activities involve an assumption of risk that could result in damage of property, injury or death to the Releasor. Releasor hereby knowingly and voluntarily assumes all such risk. Releasor authorizes the release of any and all medical records, incident reports or other related documents to the Releasee in the event of property damage, injury, or death. Releasor(s) further expressly agrees that this Release of Liability and Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Georgia, Tennessee, Kentucky, Florida, Nebraska, Ohio and that if any portion of this Contract for Use, Release of Liability and Waiver is held invalid, it is agreed that the remainder shall, notwithstanding, continue in full legal force and effect. Releasor states that this Release of Liability and Waiver as his/her own free and willful act. This agreement between Releasee and Releasor and the terms of such is contractual and not a mere recital. Releasor hereby understands that Releasor is not covered by any insurance policy held by Releasee for damage to property, injury or death. Releasor(s) further agree that they shall be liable for any damage to Releasee’s property (including ATVs, UTVs) or injury to other individuals caused by Releasor(s) negligence or willful, wanton, and intentional act(s). Releasor(s) agree to not contact farm owner/manager, ranch owner/manager, plantation owner/manager or any other volunteer connected with Releasee concerning permission for land use and any recreation activities including hunting and/or fishing privileges for releasor(s) public or private use. I hereby acknowledge that I/We have read, understand, and accept the terms and conditions stated herein, pertaining to the Contract for Use and the Release of Liability and Waiver. All persons aged 18 and older must affix his/her legal signature. By typing your name and dating this form it is your digital signature in agreement to above policies.

I agree

Electronic Signature *

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

First Name

Last Name

Preferred Date

MM

DD

YYYY