Release executed on ________________(date), by _________________________(name of applicant), of ____________________________________________________________ (address of applicant), City of _______________, County of __________, State of ________________.

In consideration of being permitted to participate in rock climbing, ice climbing, mountaineering or travel in and around mountainous terrain with or conducted by the Texas Mountaineers or its officers or members, I for myself, my spouse, legal representatives, heirs, and assigns, hereby release, waive and discharge the Texas Mountaineers, its officers and members, from all liability to me, my spouse, legal representatives, heirs and assigns, for any and all loss or damage, and any claim or damages resulting therefrom, on account of injury to my person or property, even injury resulting in my death, whether caused by the negligence of the Texas Mountaineers, its officers or members, or otherwise, while I am participating in rock climbing, ice climbing, mountaineering or travel in and around mountainous terrain.

I agree to indemnify the Texas Mountaineers, its officers and members, from any loss, liability, damage or cost they may incur due to my presence in an area in which rock climbing, ice climbing, mountaineering or travel in and around mountainous terrain occurs, whether caused by the negligence of the Texas Mountaineers, its officers or members, or otherwise.

I hereby assume full responsibility for the risk of bodily injury, death or property damage due to the negligence of the Texas Mountaineers, its officers or members, or otherwise, while in any area in which rock climbing, ice climbing, mountaineering or travel in and around mountainous terrain occurs and while working for any purpose or participating in any manner in rock climbing, ice climbing, mountaineering or travel in and around mountainous terrain.

I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the state of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

In witness whereof, I have executed this release at ______________________________ (place of execution) the day and year written above.

Signature ___________________________________________________________