RELEASE, WAIVER, AND INDEMNITY AGREEMENT

 IT IS THE INTENTION OF ___________________________________ (name) BY THIS AGREEMENT TO EXEMPT AND RELIEVE PITTSYLVANIA BAPTIST ASSOCIATION AND ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH OF MYSELF CAUSED BY ANY ACT OF NEGLIGENCE OF PITTSYLVANIA BAPTIST ASSOCIATION AND ITS OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES.

 For and in consideration of permitting ________________________________ (name) to observe, or use any facility or equipment of Pittsylvania Baptist Association, or engage in and/or receive instruction in any activity or activity incidental thereto some of which may involve dangers and risk of bodily injury at: Pittsylvania Baptist Association in the city of Danville, County of Pittsylvania, and State of Virginia, beginning on the day of _____________ (date), the signer ________________________________ (name) hereby voluntarily and absolutely release, discharge, waive, and relinquish any and all loss or damages or actions or causes of action for personal injury, property damage, or wrongful death occurring to myself as a result of my observing or using facilities or equipment of Pittsylvania Baptist Association, 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 signer, his/her heirs, executors, administrators, or assigns agrees that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against Pittsylvania Baptist Association or its officers, agents, servants, or employees, the signer will indemnify and hold harmlessPittsylvania Baptist Association and its officers, agents, servants, or employees from any and all claims or causes of action by myself or by any other person or entity, by whomever or wherever made or presented, and under no circumstances will the signer present any claim against Pittsylvania Baptist Association and said persons for personal injuries, property damage, wrongful death, or otherwise, caused by any act ofnegligence by Pittsylvania Baptist Association and said persons.

The signer has read this Release, has requested and has been provided with, or has requested and declined advisement on the potential dangers/risks of engaging 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 the signing of this Release. The signer intends his or her signature to be a complete and unconditional release of all liability to the greatest extent allowed by law and if any portion of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

SIGNATURE OF PARTICIPANT: _________________________________________________

DATED: _______________________________