Spouse or other emergency contact

Please provide the information of the person you would consider your closest friend or family member. This person must be different than your emergency contact.

This WAIVER OF LIABILITY, RELEASE AND INDEMNITY AGREEMENT ("Release") is made by the adult registering online (The PARTICIPANT) to release and indemnify Breakthrough Covenant Church, affiliated corporate entities, and all their representatives, and assignees (collectively "Breakthrough Covenant"), as set forth below: PARTICIPANT hereby grants Breakthrough Covenant this full waiver of liability, release, and indemnification in exchange for permitting PARTICIPANT to partake in the Well scheduled to take place at a designated Center, located in Random Lake, WI for the dates the individual had registered. PARTICIPANT will be required to comply with the established rules of BREAKTHOUGH COVENANT CHURCH Release, Waiver, and Indemnity: PARTICIPANT voluntarily participates in the activity including being transported to and from the venue of the activity where applicable with the full knowledge and understanding and appreciation of the risks of injury and or danger that is inherent in participating in the activity which will include ground transportation of the PARTICIPANT, and expressly assumes all risks of injury, danger and harm, and even death which may occur by reason of participation in the activity; PARTICIPANT agrees to release, indemnify, defend, and be fully responsible for anything that occurs by reason of the PARTICIPANT's participation in the activity and; (1) the negligent acts or omissions of BREAKTHROUGH COVENANT; or (2) the negligent, grossly negligent or intentional acts or omissions of participant; or (3) the negligent, grossly negligent or intentional or acts OR omissions of any 3rd party ; PARTICIPANT, by signing below, certifies and fully understands that this release will provide an absolute defense to any lawsuit or claim against BREAKTHROUGH COVENANT CHURCH for any injuries or damage that the PARTICIPANT may incur by reason of PARTICIPANT's participation in the activity. MEDICAL; PARTICIPANT consents to emergency medical care and transportation in order to obtain treatment in the event of any injury to PARTICIPANT, as BREAKTHROUGH COVENANT CHUCRH may deem appropriate. This release extends to damage or loss rising out of the medical treatment and transportation provided in the event of an emergency, including the negligent acts or omissions of any health care providers, their agents employees, or representatives. Severability: If any provision or portion of this Release is found to be invalid by a court of competent Jurisdiction, the remaining portions and provisions shall remain effective and shall be construed as if the invalid portion of the provision had not been contained herein.

I understand that all costs are transferable, but not refundable, up to 2 weeks prior to the day of departure. After that, if you are unable to attend, any monies collected will be considered a donation to the WELL.