Revolution Five Student Application

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH Revolution5 Leadership Institute, (hereinafter referred to as "Rev5"), of 2621 W. Cucharras, Colorado Springs, Colorado, 80904 and/or use of the property, facilities and services of Rev5, and I, , agree to the following: I recognize that there are certain inherent risks associated with attending Rev5 and I assume full responsibility for personal injury to myself, and further release and discharge Rev5 for injury, loss or damage arising out of my presence upon the facilities of Rev5, whether caused by the fault of myself, Rev5 or other third parties. I agree to indemnify and defend Rev5 against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my use of or presence upon the facilities of Rev5. I agree to pay for all damages to the facilities of Rev5 caused by my negligence, reckless, or willful actions. I certify that I am physically fit, have sufficiently prepared or trained for participation in Rev5, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems that preclude my participation in this activity. I acknowledge that Rev5 may involve a test of a person's physical and mental limits and carries with it the potential for serious injury, death, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, staff, officers and/or other contributors to Rev5. These risks are not only inherent to participants, but are also present for staff and volunteers. In consideration of my application and permitting me to participate in Rev5, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE Rev5, and/or its directors, officers, employees, volunteers, representatives, sponsors, volunteers, teachers or assigns, from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me, including my traveling to and from Rev5: (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in Rev5, whether caused by the negligence of release or otherwise. I acknowledge that Rev5 and its directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during Rev5. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by Rev5, its producers, sponsors, and assigns. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Rev5, or the employees, representatives or agents of Rev5. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND THAT I UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A DIGITAL RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. I FURTHER UNDERSTAND THAT BY SUBMITTING THIS DIGITAL RELEASE OF LIABILITY FORM, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.