Please copy/print the following form, fill it out, and mail or fax it to

Water For The Nations, 5897 Saratoga Drive, Crestview, FL 32536

Phone: 850-682-9144; Fax: 850-682-9135; Email: info@wftn.org

RELEASE AND HOLD HARMLESS AGREEMENT FOR DRILL TRAINING CAMP

Date of Training Seminar:

Whereby, I, (full name) _________________________________________________________________ have applied to attend drill training with representatives of Water For The Nations, Inc. (WFTN), and whereas I am doing so entirely upon my own initiative, risk and responsibility, now therefore, in consideration of WFTN accepting me into its training program and undertaking to arrange matters of transportation, lodging, and food and of permitting me to view and/or work on training on the use of the drilling equipment, I do hereby, for myself, my heirs, executors and assigns, release and forever discharge WFTN and any of its affiliates or subsidiaries, Directors, officers, agents, employees, or volunteers, acting officially or otherwise, and all trainers and property owners, and/or managers from any and all claims, demands, actions or causes of action on account of my death, or any injury to me or my personal property, which may occur from any cause, including negligence of any type, during said trip. Therefore, neither WFTN nor any of its affiliates or subsidiaries, Directors, officers, agents, employees, or volunteers, shall be or become liable or responsible for any loss, injury or damage to person, property or otherwise in connection with, by way of example but not by way of limitation, accommodations, transportation or other services, resulting directly or indirectly from any acts of God, dangers, incident to the sea, air, land, fire, breakdown or misuses in machinery or equipment, thefts, pilferage, epidemics, changes in itinerary or schedules or from delay, and that neither WFTN, nor any of its affiliates or subsidiaries, Directors, officers, agents, employees and volunteers shall be or become liable or responsible for any additional expenses or liability sustained or incurred in training or on the property where training occurs as a result of any of the foregoing causes or any other unnamed cause.

This Agreement shall be governed by the laws of the State of Florida. By executing this Agreement, I acknowledge that I have read and accept all of its terms and conditions.

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Signature

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Street Address

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City, State, Zip

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Phone

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Social Security Number

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Occupation

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Birthplace Birthdate

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Place of Execution of Agreement

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Date of Execution of Agreement

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Print Witness Name

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Signature of Witness