Titus II Dance Ministry Photo and Injury Release Form

1. My involvement and/or participation in the Raise the Gates conference is voluntary, and I am acting under my own free will.
2. There is a risk of bodily harm and injury, as a result of my participation. The risks arise from dance activities, with the acknowledgement that potential risks are not limited to this activity.
3. There is the potential for risks and injuries that may not be obvious or reasonably foreseeable at this time.
4. Titus II Dance Inc. undertakes no direct legal or financial responsibility for my personal safety or well being when I am participating in  the Raise the Gatesconference
5. I assume the risks, including, but not limited to, those outlined in Section 3 of this agreement.
6. I forever release Titus II Dance Inc. from any and all claims and causes of action that I or my representatives now have or may have in the future for personal injury, property damage or wrongful death occurring to me, arising out of participation intheRaise the Gatesconference
7. I am 100% liable for all medical expenses incurred as a result of any injury or property damage during my participation in the Raise the Gatesconference.
8. In the event that any one or more of the provisions of this agreement shall be held to be invalid, illegal, unenforceable or in conflict with the law according to the jurisdiction of the state of NC,  the remaining portions will not be invalidated, and shall remain in full force and effect.
9. This is a legally binding contract, but it is not meant to pronounce any claims or defenses that are legally prohibited.

10. I authorize Titus II Dance Inc., its assigns, and transferees to copyright, use, and publish the same in print and/or electronically. I agree that Titus II Dance Inc. may use such videos and photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.  I have read and understand the above: