By signing here I grant In The Gap, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize In The Gap, its assigns and transferees to copyright, use and publish photos in print and/or electronically

I, the below stated, in consideration for the training and the experience which I will receive through volunteer service projects with In The Gap, do hereby release In The Gap, as well as its employees, agents, and voluntary helpers (releasees) from any and all liability arising from any and all injuries to myself, or property damage to my belongings, which may occur while I participate in service with In The Gap. I recognize the potential for physical injury to which I may be exposed in the course of my training and service, but I knowingly and freely assume all such risks, even if arising from the negligence of the releasees or others, and I assume full responsibility for my participation. In consideration of the aforementioned benefits, I voluntarily authorize In The Gap, and any of its employees, agents, or other volunteer supervisors responsible for my well-being, to personally provide or to make reasonable arrangements for any emergency medical care which should become necessary while I am participating/working with In The Gap. I understand that, should emergency care be necessary, my emergency contacts (as referenced below) will be contacted as soon as is reasonably possible. I further state that I have carefully read the liability and medical release below, that I understand its content, and that I willingly agree to the contents thereof. I fully understand the arrangements made for my personal care, and willingly consent to In The Gap's provision for my spiritual, emotional, mental, and physical welfare during the period of time I am under the authority of In The Gap. I voluntarily, and of my own free will, sign this release of liability and medical consent form.

In connection with my future involvement as a staff member or a volunteer working with youth or children, I, the below stated, understand that In The Gap and/or its agents, may conduct a background check and obtain all records whether they are of a public, private, or confidential nature to determine my ability to minister in this role. It may include information concerning my character, work habits, performance, and any court records that may have a bearing on my job responsibilities. I acknowledge that a telephonic facsimile (fax) or photographic copy shall be as valid as the original. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, schooling agency or its agent, to furnish the information described above. In addition, I release and discharge In The Gap and its agents and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs, expenses, or any other charge or complaint filed with any agency arising from retrieving and reporting this information. I understand that if any of those records contain information that is used to deny my services at In The Gap, I will be notified of my rights and where I can obtain a copy of the information. I understand that a complete listing of my rights under the Fair Credit Reporting Act can be obtained at www.ftc.gov/credit. By typing your name here, you are signifying that you have read, understand, and agree to the above authorization. This is your legal signature.