I (print name) ______________________________ for good and valuable consideration, the receipt of which is acknowledged give to The Ecclesia, their legal representatives, successors,  and all persons, corporations, or entities connected with and or acting with their permission, confirmation I have read, understood and agree to the following.

1.      I am at least 18 years of age and am freely and voluntarily choosing to attend and participate in this event and to view and/or participate in activities that I know are adult oriented and sexually explicit and that involve acts of domination, submission, bondage, discipline, sadism and masochism, and other explicit and extreme sexual fetishes and activities, including, but not limited to, spanking, paddling, whipping, waxing, piercing, fire play, knife or edge or blood play, bondage, suspension, fisting and other oral, vaginal and anal penetration. I understand that these activities involve certain risks, including, but not limited to, the possible negligent or reckless conduct of other participants. Initials: ______.

2.      I AM AWARE THAT THESE ACTIVITIES ARE CONSIDERED EXTREMELY HAZARDOUS ACTIVITIES. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH FULL KNOWLEDGE OF THE DANGERS INVOLVED, AND I ACCEPT AND I ASSUME FULL RESPONSIBILITY FOR ANY AND ALL RISKS OF PROPERTY DAMAGE, PERSONAL INJURY OR DEATH. I VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE: ________.

3.      As consideration for being permitted to enter the event, and to view and participate in these activities, and to use the facilities and equipment being provided, I agree that neither I nor anyone through me or on my behalf will make any claim against or sue The Ecclesia or anyone affiliated with The Ecclesia including, but not limited to, the owners, their legal representatives, successors,  and all persons, corporations, or entities connected with and by extension friends, associates, guests, agents, employees, employers, teammates, landlords, volunteers, promoters, sponsors and contractors, owners, lessors or suppliers of the premises, and the owners, lessors or suppliers of any equipment used in connection with the event, for any injury or damage suffered by myself (named above) at any time during my presence at the event or as a result of my participation in any activities at the event, and I hereby release, waive and forever discharge them, their heirs, administrators, executors and assigns, from any and all claims, demands, actions or rights of action, of whatever kind or nature, either in law or in equity, arising from, or by reason of, my attendance at, or participation in, the event or activities. Initials: _____.

4.      Indemnity and Hold Harmless
I agree to indemnify and hold The Ecclesia, and all those individuals and entities described in paragraph 3 above, from any loss, liability, injury, damage or cost that they may occur or that they may incur due to my presence or my actions at the event, whether caused by my negligence or otherwise. Initials______.

5.      I hereby also agree to follow the rules, safety and instructions of The Ecclesia, I acknowledge it is my responsibility to ensure I adhere to and keep up to date with current rules, safety, procedures and as such understand failure to comply will result in my expulsion and termination of membership at any time with no notice.  Initials: _____.

6.      Knowing and Voluntary Execution
I HAVE CAREFULLY READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND The Ecclesia AND THAT I AM GIVING UP MANY LEGAL RIGHTS AND REMEDIES BY SIGNING IT. Initials ______.