(COPY AS NEEDED)

RELEASE OF LIABILITY

AND PARE= NT PERMISSION FORM

Cross Cu= lture Experiences, Inc. (dba Mission Waco)

(And as applicable for joint projects with Waco Community Developme= nt Corp.)

Required for the following activities: Check all that apply for this rele= ase.

_ X _ Poverty Simulation, Waco, TX

___ Climbing Wall at Jubile= e Center, 1319 N. 15^th,= Waco, T= X

___ Out of Country Mission/Exposure Trip: Specific which country - ____________________

___ Special Outing or Field Trip: Describe _________________________= ________________

___ Mission Waco Program(s) including transportation:<= span style=3D'mso-spacerun:yes'> Describe _______________________

_X_Volunteerism in Mission Waco programs

___Construction/Work Projects

Whereas, the undersigned participant wishes to be acce= pted for participation in one or more of the activities listed above which is organized by Cross Culture Experiences, Inc. / Mission Waco, of Waco, TX and regarding Cross Culture Experiences, Inc. / Mission Waco’s action in allowing the applicant to participate in such activities or programs, the undersigned acknowledges that the activity does involve certain risks. The activities are designed to all= ow the participant to broaden their understanding of various Christian values, socio-economic differences, ethnic and racial diversity, cultural appreciat= ion, team building, character development, and/or enrichment opportunities. These activities include those lis= ted above, but are not limited to, and activities in a lower income neighborhood and among poor people in Waco<= /st1:City>, TX, other communities, and foreign countries. I understa= nd that participants are exposed to physical and psychological risk through elements of nature, travel by car, van, plane, walking, or other conveyance, and direct contact with people from various backgrounds. Risks may also include damage or l= oss of personal property. Risks may = also include physical injury and/or strenuous physical activity at work/construc= tion sites, the Climbing Wall, or during other activities. I further understand that immediate medical treatment may be difficult or delayed, especially in foreign countries. I understand that = some work projects in the Waco neighborhoods will be coordinated with and superv= ised by Waco Community Development Corporation, a separate non-profit from Misson Waco that works with housing and economic development in Waco.

In consideration of the above, I have and do hereby as= sume all the above risks and any other ordinary risk incidental to the nature of= the program, including risks which are not specifically foreseeable, and will h= old harmless and indemnify Cross Culture Experiences, Inc. / Mission Waco, its Board of Directors, employees, agents, and/or Associates, and Waco Community Development Corp., its Board of Directors, employees, agents, and/or Associ= ates from any and all liability. T= he terms hereof, and my signature on this document shall serve as a release and assumption of risk, and shall bind my heirs, representatives, executors, administrators, successors and assigns and for all members of my family, including any minors accompanying me. I also state that I am not under, and will not be under the influenc= e of any non-prescribed chemical substance, including alcohol. I also state that I will assume responsibility for any damage or loss to physical property or expenses incu= rred due to negligent or irresponsible behavior. I understand that my participation= in this Cross Culture Experiences / Mission Waco program or activity is entire= ly VOLUNTARY.

My signature also gives my permission and accepts fina= ncial responsibility, as well, for first aid treatment and/or professional medical attention if needed. I also g= ive permission for photographing of myself or my child during the activities and use of those pictures or video by Cross Culture Experiences, Inc. / Mission Waco.

_______________________________ _________ &= nbsp; ______________________________ &= nbsp; ___________

PARTICIPANT SIGNATURE = = DATE &= nbsp; WITNESS &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; DATE

_______________________________ _________ &= nbsp; ______________________________ &= nbsp; ___________

PARENT/GUARDIAN SIGNATURE= &= nbsp; DATE &= nbsp; WITNESS &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; DATE

FOR ANY PARTICIPANT UNDER AGE 18

Please pri= nt legibly – Each participant must complete this section:=

Participant Name: ______________________________ &= nbsp; Age: ______________ = ; Phone: ( = ) ____________

Address: &n= bsp; = ; _____________________________________ = City: ______________ = ; Zip: ______________________

In case of emergency, please contact: __________________________________= ____ Phone: ( = ) ____________

Contact’s relationship to participant: _________= ______________________________________