Parent/Guardian/Emergency Contact #1:

Parent/Guardian/Emergency Contact #2:

WAIVER, ASSUMPTION OF RISK, RELEASE, INDEMNIFICATION, AND CONSENT AGREEMENT ("RELEASE") FOR MINOR
I am over eighteen years of age and a parent or legal guardian of the Minor named above who is under eighteen years of age ("Minor"), and I am fully competent to sign this Release. Other than as fully and expressly provided above, I certify that Minor is in good health, has no mental or physical conditions that would prevent his or her participation in the Camp and/or its recreation activities (including, but not limited to, team sports, swimming. and climbing), and that Minor has no condition that requires the taking of medication on a regular basis, except as fully and expressly indicated above. In consideration of Minor being permitted to participate in the Camp's activities and to use the facilities and equipment at the Camp, I, on behalf of myself, Minor, and Minor's representatives, executors, heirs, next of kin, administrators, beneficiaries, successors and assigns (collectively, the "Minor's Representatives"), hereby agree to be bound by this Release. I understand that such participation or use entails certain inherent risks to Minor, and I, on behalf of Minor's Representatives, voluntarily accept all risk to Minor's health that may result from such participation or use. Therefore, I, on behalf of Minor's Representatives, hereby agree that GO TELL MINISTRIES, INC. ("GO TELL"), its directors, officers, employees, agents, representatives, related and/or affiliated entities, successors and assigns (hereinafter, "Released Parties") SHALL NOT BE LIABLE FOR ANY DAMAGES arising from (a) the DISCLOSURE OF MEDICAL INFORMATION contained in this form (if believed necessary by the Released Parties), and/or (b) PERSONAL INJURIES (INCLUDING DEATH), DAMAGE TO OR LOSS OF PROPERTY OR OTHER HARM, whether foreseen or unforeseen, present or future, known or unknown, that Minor may sustain in any way which directly or indirectly results from or arises from Minor's attendance or participation in the Camp or resulting medical treatment. Furthermore, I, on behalf of Minor's Representatives, agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS the Released Parties from and against any and all claims, foreseen or unforeseen, present or future, known or unknown, that Minor's Representatives may have or assert, EVEN IF CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE, FAULT, BREACH OF CONTRACT, STRICT LIABILITY, OR OTHER ACT, CONDUCT OR STATUS of any of the Released Parties. This indemnification includes all costs of defending such claims, including attorneys' fees, costs, and expenses, whether suit is filed or not.

Release of Medical Information and Treatment I, on behalf of Minor's Representatives, give my express, written consent allowing the Released Parties to share Minor's Personal Information, as well as any information in its possession regarding any health or medical conditions and any applicable health insurance coverages that Minor may have, to or for the use of a medical provider in the event that a Released Party believes it is reasonably necessary for the provision of medical care to Minor. I further authorize emergency medical treatment to be performed by Camp medical staff and/or attending physicians at the local clinic or hospital to my child in my absence, as they deem necessary.
Media License. I, on behalf of Minor's Representatives, hereby assign and grant to GO TELL and the other Released Parties AN IRREVOCABLE, PERPETUAL, ROYALTY-FREE LICENSE TO USE MINOR'S NAME, PHOTOGRAPH, IMAGE, VOICE, LIKENESS AND ANY IDENTIFIABLE ATTRIBUTES, IN WHOLE OR IN PART, IN ANY MEDIA (the "Images") for development or charitable solicitation, advertising, trade and any other lawful purposes now and in the future without further notification, inspection or approval and at no cost to the Released Parties and with no compensation to me or to Minor (provided, however, that neither GO TELL nor any other Released Party shall be obligated to use the Images in any way), and I further agree that GO TELL shall be the exclusive owner of any and all rights, including copyrights in the Images.

Mandatory Arbitration. Consistent with Matthew 18 in the Holy Bible, any claim or dispute between the parties concerning questions of law or fact or both arising out of or relating to this Release, its interpretation or performance, or its alleged breach, which is not disposed of by agreement of the parties, shall be resolved by binding arbitration in Atlanta, Georgia by and under the rules of Peacemaker Ministries (or its successor) except as such rules are modified here. Those rules are currently published at www.peacemaker.net. The parties covenant to keep such questions and arbitration proceedings confidential except as necessary to effectuate and/or enforce arbitration. The parties covenant and agree that they will not sue or otherwise bring actions against each other in any courts, that arbitration is their sole and binding remedy, that they waive their rights to sue or to appeal or to other remedies (except to the extent necessary to enforce the final award or finding), and that if this covenant not to sue and waiver are not legally effective, then such arbitration is a prerequisite to any other remedy. The parties covenant and agree to abide by, perform, accept, and fulfill the final award or finding concerning such questions without recourse to any other court or tribunal, except to the extent necessary to enforce said final award or finding.

Opt-Out of Release of Personal Information. Unless the box is checked immediately below, I permit GO TELL to release a portion of Minor's personal information (name, address, gender, age, email & d/o/b only) to Christian colleges/universities that are involved with the GO TELL Ministries Internship Program. The institutions include: Liberty University, Campbellsville University & Mississippi College. Further, I authorize the institutions listed herein to contact Minor at the address and/or email address provided by GO TELL for purposes of communicating with Minor and providing information concerning the institution and its offerings.

This Release contains the entire agreement between the parties, and may be amended only in writing signed by the undersigned and the Released Parties' representative(s), or their successors. It is not intended to release the Released Parties from any conditions or activity that, as a matter of law, cannot be avoided, waived or released, and no provision hereof should be so interpreted. It is governed by the internal laws of Georgia (even if applicable conflict of law rules would provide otherwise). Its terms are severable. It shall not be strictly construed against any party. I HAVE READ AND UNDERSTOOD THIS RELEASE, AND I ACCEPT AND AGREE TO ITS TERMS AND SIGN IT VOLUNTARILY.