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Youthnited May 18, 2013

Realife Media, Inc. 1527 South Rogers Street Bloomington, IN 47403 812-333-3951 800-979-8999

www.realifemedia.com ACKNOWLEDGEMENT OF RISK, WAIVER, AND RELEASE FROM LIABILITY I acknowledge utilizing the various rides and entertainment facilities and equipment of Realife Media, Inc. including but not limited to the Youthnited, Youth4Christ, Younglife, Fellowship of Christian Athletes, Sherwood Oaks Christian Church, Evangelical Community Church, Emmanuel Baptist, City Church, Genesis, Exodus, Southside Christian, G.O. Ministries, Soles4Souls inc., Paradise Uganda, Cade Chudy, Greg & Suzanne Buehler, Ken Hydinger, carries a potential for serious personal injury or death. I hereby assume the risk of utilizing such rides and entertainment facilities and equipment and I certify that I am sufficiently physically fit to participate in such activities. I, for myself and my executers, administrators, heirs, next of kin, successors, and assigns and anyone else who might claim or sue on my behalf, do hereby waive, release, and discharge from all claims, losses or liabilities for death, personal injury, or sickness, partial or permanent disability, property damage, medical or hospital bills, or damage of any kind arising out of my participating in or utilization of the various rides and entertainment facilities and equipment, Realife Media, Inc. and their respective owners, directors, officers, employees, agents, and representatives, regardless of whether such claims, losses, liabilities are caused by the negligent acts of omission of any other persons or entities. I promise and agree not to sue any of the persons or entities mentioned above for any of the claims, losses or liabilities that I have waived, released or discharged herein and I agree to indemnify and hold harmless the persons or entities mentioned above from any and all claims made or liabilities assessed against them as a result of (a) my actions or inactions, (b) the actions or inactions or negligence of others including those parties hereby identified or (c) the condition of the rides and entertainment facilities and equipment or (d) and other harm caused by, or related to my using the rides and entertainment facilities and equipment. In the event that the undersigned is consenting to permit a minor (under 18 years of age) or minors to participate in and to utilize the rides and entertainment facilities and equipment, the undersigned does hereby agree to indemnify and hold harmless, Realife Media, Inc. and those persons and entities above described from or against any and all claims, liabilities, losses, personal injury, disability, or medical or hospital bills of such minor or minors to the full extent described herein. I expressly agree that the foregoing acknowledgment, waiver, and release liability is intended to be broad and inclusive as is permitted by the law and if any portion is held invalid, the balance shall continue in full force effect. I hereby affirm that I am eighteen (18) years of age or older, that I have read this document and understand its contents and that I voluntarily sign this document without any oral representation or statement having been made to induce me to sign this document. If I am not 18 years of age, my guardian will sign for me. Name:_________________________________________ Date:________________________________ We Checked ID:_______________________DL:_______________________STATE:____________ MINOR Childs Name:_____________________________________________________________________ Parents Signature:_________________________________________________________________