tour release form

---

PRISON PREVENTION MINISTRIES, INC. STUDENT - PARENT/GUARDIAN RELEASE AND INDEMNITY AGREEMENT for CCA Silverdale Tour / Ministry Video / Mentoring

Please Print or Type Clearly _________________________________________________ STUDENT NAME: Last First MI

□MALE

□FEMALE CHECK ONE

____________________________________________________________________________ PARENT/GUARDIAN NAME ____________________________________________________________________________ ADDRESS: Street City ST Zip ____________________________________________________________________________ AGE Date of Birth Phone # Grade ____________________________________________________________________________ SCHOOL NAME ____________________________________________________________________________ INSTITUTION Prison and Prevention Ministries, Inc. is not covered by liability insurance for any of its activities, including transportation to and from such activities. Therefore, each student and his/her parent/guardian participating in any of PPM’s programs is asked to sign the following release and indemnity agreement: I hereby release Prison Prevention Ministries, Inc., its employees, staff, Board of Directors and sponsors from all actions, causes of action, claims, damages, demands, judgments, and executions of any and every kind of nature whatsoever which I may have arising from my participation in the above described activity; and, I agree to indemnify and hold harmless Prison Prevention Ministries, Inc., its employees, staff, Board of Directors and sponsors from all claims and causes of action arising in favor of the above student in connection with the described activity. I have read the outline of the Prison Prevention Program and understand that a PPM staff member may counsel with my child individually. I also give permission for this student to participate in the Prison Prevention video. It is my understanding this video will not be sold or rented to anyone and will be used only by the ministry as a promotional tool. I have read and understand all of the terms of this release and indemnity agreement. I execute it voluntarily and with full knowledge of its significance.

____________________________________________________________________________ Signature of Student Date Signed

____________________________________________________________________________ Signature of Parent/Guardian Date Signed

WHAT IS THE PRISON PREVENTION PROGRAM? PPM’s Prison Prevention Program is a very effective tool used by schools, church youth groups and other organizations as a deterrent to teens that may be considered at-risk. WHAT’S INVOLVED?  Orientation  Talk with Inmates  Question and Answer Session with Inmates  Tour of CCA Silverdale Facility  Group and One-on-One Follow-ups by PPM Staff  Mentoring by PPM Staff OTHER OPTIONS Small Group Presentations or Assemblies Classroom Lectures REQUIRMENTS Students Must be 13 Years of Age Maximum of 25 Students Allowed on any Given Tour Five staff invited Wavier Forms for PPM, the Prison and Participation Group must be signed by each student and parent/guardian in order to participate in tour PPM is not responsible for transportation Transportation must be arranged and provided by participating group Notify PPM: Six to eight weeks before desired tour date Two to three weeks prior to assembly date

RULES FOR STUDENTS 1. Respect all staff and students. 2. Seating on bus will be determined by staff. 3. Do not distract bus driver. 4. No profanity, obscene gestures, inappropriate language, or shouting. 5. No horse play or inappropriate touching. Keep hands and feet to yourself. 6. No electronic devices during trip. This includes cell phones, game boys, cd players, MP3 players, I Pods, PSPs, etc.

PRISON PREVENTION MINISTRIES 302 SPRUCE STREET / CHATTANOOGA, TN 37404 423.622.5768

FACILITY TOUR RELEASE AGREEMENT

I, __________________________, hereby request by this Facility Tour Release Agreement ("Release") to be allowed to tour Silverdale Correctional Facility located at 7609 Standifer Gap Road, Chattanooga, TN 37422 ("Facility"), which is currently operated by Corrections Corporation of America ("CCA"). I acknowledge that my visit is totally voluntary and understand that a tour of a correctional facility carries inherent risks which I knowingly and willingly assume. CCA has made no representation to me about the suitability or safety of any such tour and neither CCA, nor any employee of CCA, shall be responsible for coming to my aid in the event of an emergency, accident or incident during the tour. On behalf of myself and any and all heirs, successors and assigns, I hereby release CCA, and any and all CCA employees and representatives from all liability for injury to me regardless of the nature, manner or severity of the injury, including death, and for any and all property damage sustained by me while on the Facility premises. By signing this release I am acknowledging: (1) that I have read this Release in its entirety and fully understand the terms and consequences, (2) that a correctional facility tour by its nature is a potentially hazardous activity that has inherent risks, (3) that all personal property of any kind belonging to me that I bring onto the Facility premises in connection with the tour shall be at my sole risk and expense, and that CCA, its employees, and representatives shall not be liable for loss or damage to such property, and (4) that I expressly assume any and all dangers, risks, and hazards arising from my presence at the Facility during such tour, whether or not explicitly set forth herein. I further agree to fully comply with the Tour Guidelines attached hereto as Exhibit A. This Release is executed this _____ day of _____________, 20__ as follows: ____________________________________________________________ School/Organization (PLEASE PRINT) ______________________________________________ Tour Participant (Please PRINT VERY CLEARLY)

__________ Grade

_________ Age

___________________________________________________________________ Social Security Number of Participant (PLEASE PRINT VERY CLEARLY) ____________________________________________________________________ Birthday of Participant (PLEASE PRINT VERY CLEARLY) ____________________________________________________________________ Signature of Participant ____________________________________________________________________ Signature of Parent or Guardian (REQURIED IF PARTICIPANT IS A MINOR)

EXHIBIT A TOUR GUIDELINES 1. It is imperative that all tour groups arrive at the Facility twenty minutes earlier than the time scheduled for the tour. CCA maintains the right to cancel a tour if participants arrive late. 2. All participants, regardless of age, must present a signed Release to security staff upon their arrival at the Facility. Persons who fail to comply with this requirement will not be admitted into the Facility. 3. No handbags, fanny packs, backpacks or similar items are allowed in the Facility. 4. Tour participants must comply with the Facility dress code:  Shorts are not allowed  Skirts/dresses must be no shorter than 2” above the knee  White T-shirts are not allowed  No obscene, suggestive or political printing on clothing  No open toe shoes/sandals are permitted.  All items of clothing must be worn appropriately on the body  Earrings will not be worn by any tour participants  Hats will not be worn inside the Facility. 5. A picture ID will be required of each participant 6. Tour participants will not be allowed to carry anything into the Facility. It is recommended that jewelry be left at home or locked in the person’s vehicle. 7. Vehicles must be secured while on the Facility grounds. Doors must be locked; windows must be closed; keys must be removed from the vehicle and secured at the Visitation Control Room inside the institution. Valuables must not be visible to persons walking by the vehicles. 8. No cameras or recording devices are allowed. 9. Persons who display an inappropriate attitude toward Facility staff will be immediately removed from the Facility and will vacate the premises.