VBS Registration

Indemnity and Release Form I, the undersigned, wish to voluntarily participate in the VBS. In consideration for being permitted to participate in VBS, in the city of El Segundo in the state of California, and country of The United States of America, beginning the 22nd day of June, 2026, I, the undersigned, fully recognizing the dangers and hazards inherent in VBS, and any related transportation, including personal injury, property damage, or wrongful death, as well as the unknown dangers and hazards which may arise in the course of my participation in the VBS, do hereby voluntarily: Agree, for myself, my heirs and my personal representative, to defend, hold harmless, indemnify, release and forever discharge, to the broadest extent allowed by law, New City Church, its trustees, officers, employees, agents, insurers, successors, assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result from my participation in the above VBS. I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to indemnify New City Church, for injuries, damages or losses I may cause and giving up rights to sue New City Church for injuries, damages or losses I may incur. THIS RELEASE WAS RESEARCHED AND DRAFTED BY THE LAW FIRM OF: MERSEREAU SHANNON LLP ONE SW COLUMBIA STREET, SUITE 1600 PORTLAND, OR 97258 (503) 226-6400 kvickers@mershanlaw.com IT IS MADE AVAILABLE AS SAMPLE RELEASE/WAIVER WITH THEIR PERMISSION. NEITHER MERSEREAU SHANNON LLP NOR CHURCH MUTUAL INSURANCE COMPANY, S.I. (A STOCK INSURER)1 WARRANT THAT IT IS APPROPRIATE FOR USE BY ANY OF OUR INSUREDS. THE RELEASE/WAIVER WAS DRAFTED AS A SAMPLE DOCUMENT AND MAY NOT BE APPROPRIATE FOR THE SPECIFIC NEEDS OF A PARTICULAR ORGANIZATION. THIS RELEASE, WAIVER, AND INDEMINTY AGREEMENT IS NOT A SUBSTITUTE FOR GOOD PRACTICE, PROPER SUPERVISION, AND REPAIR. THERE IS NO GUARANTEE THAT THIS RELEASE WILL PROTECT ANY FACILITY THAT CHOOSES TO USE IT. BEFORE USING THIS SAMPLE DOCUMENT OR ANY DOCUMENT LIKE IT, YOU SHOULD CONSULT WITH YOUR OWN ATTORNEY TO MAKE CERTAIN THAT THE DOCUMENT YOU EVENTUALLY USE IS CORRECT AND CURRENT UNDER THE LAW OF YOUR PARTICULAR JURISDICTION AND THAT THE DOCUMENT MEETS YOUR NEEDS FOR YOUR PARTICULAR SITUATION. 1Church Mutual® is a stock insurer whose policyholders are members of the parent mutual holding company formed on 1/1/2020. S.I. = a stock insurer. -1- CM0174 (04/2020)

VBS Registration

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