Please carefully read the following Release Form and acknowledge your agreement with your signature.

Introduction
By signing below, I am agreeing to release The Christian & Missionary Alliance (The C&MA) and other parties from liability. I am also granting permission to The C&MA to seek and obtain medical care in the event of my illness or injury. I have therefore been advised to read this document carefully and understand that I have the opportunity to consult with an attorney before signing. I understand that participation in this internship is a privilege. I am signing this Release of Liability in consideration for that privilege. I acknowledge that my participation in this trip may involve risks of physical injury, illness, or death, including risks of which I may not presently be aware, and I hereby agree to assume such risks.
Release & Indemnification
I hereby agree to release and hold harmless The C&MA, members of its board of directors, and its officers, employees, members, volunteers, and agents and sponsoring church (collectively, the "Released Parties") from, and to discharge and waive, any and all claims, demands, losses, damages and liabilities described therein, whether known or unknown, foreseen or unforeseen, future or contingent, except claims, demands, losses, damages and liabilities arising out of the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties. I further covenant not to sue any of the Released Parties in connection with any of the claims, demands, losses, damages or liabilities described above. I further agree to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages or liabilities for indemnities, contribution or otherwise with respect to any and all property damage, personal injury and/or death arising from my participation in Envision, as may be asserted by a third party (defined as any party other than the Released Parties or me), except to the extent that such a claim might be based upon the sole and exclusive gross negligence or willful misconduct of one or more of the Released Parties.
Authorization of Medical Care
I attest and certify that I have no known medical conditions that would prevent me from participating. I understand and acknowledge that The C&MA, together with the sponsoring church, provides foreign trip insurance coverage as a part of the cost of the internship. I understand and acknowledge that the provided coverage is not intended to take the place of a personal or group health insurance plan and may not specifically apply in every event of my illness, injury, death, or damage to my property that may occur during participation in this internship. I hereby certify that I am covered by a personal or group insurance plan, which I will carry on my person or in my belongings for the duration of the internship, to have in case of hospitalization and medical expenses beyond the coverage provided by the foreign insurance coverage noted above. In case I am in need of any necessary medical or surgical treatment to protect my health and welfare while participating in this internship, I authorize and allow any authorized agent or employee of The C&MA to consent to and authorize the administering of such necessary medical and/or surgical treatment. I have provided emergency contact information and personal health information in the Intern Medical Form. I authorize the release of this information when needed for the administration of such necessary medical and/or surgical treatment. I acknowledge and agree that the release of liability, hold harmless, and indemnification provisions set forth in this release above shall apply to any authorization and consent to medical and/or surgical treatment on my behalf made by The C&MA or its authorized agents or employees.
Mediation/Artbitration
The C&MA and I agree that should a claim or dispute arise from my participation in this internship, it shall be settled by biblically based mediation and, if necessary, legally binding arbitration under a Christian mediation or reconciliation process in accordance with the Rules of Procedure, promulgated by Peacemaker Ministries, Inc. of Colorado Springs, Colorado, United States of America, or its successor. The venue for such mediation or conciliation process shall be Colorado Springs, Colorado, or such other location agreed upon by both parties. Judgment upon an arbitration award may be entered in any court otherwise having jurisdiction.
Miscellaneous
I expressly waive any defense to the enforcement of any provision of this Release arising from a claim of lack of consideration. In the event that any provision of this Release is determined to be invalid or unenforceable, the remainder of the provisions shall remain in full force and effect as if this Release had been executed with the invalid provision eliminated. I understand and agree that this Release is intended to be as broad and inclusive as permitted under applicable law. The undertakings and covenants of this Release shall be binding on me, my family, my heirs, next of kin, legal representatives, beneficiaries, successors, and assigns. This Release shall be interpreted in accordance with the laws of the State of Colorado. The terms of this Release are contractually binding and are not a mere recital. This Release shall be effecting and binding upon me. I have read this Release and understand its terms. I further represent that I am at least eighteen (18) years of age and am not a minor in my State of residence.
Today's date *
Today's date