Car Show & Motorcycle Show • May 27, 2023

CONSENT, ACKNOWLEDGEMENT & RELEASE

Consent & Waiver/Release:  By signing this form and/or related documents, the participant is requesting and contenting to participate in the noted event, activity or program.  As consideration for participating participant, on behalf of participant and participant’s family, representatives, successors and assigns (“releasors”), hereby releases, waives, discharges, and covenants not to sue Birth Choice Centers and/or 412 Church San Jacinto, its related entities and its community sponsors or partners, as well as their officials, officers, employees, agents, volunteers, successors and assigns, from and for any and all liability for any loss or damage suffered by participant, releasors or any third party which is in any way related to the event.

Acknowledgement:  Participant understands, acknowledges and agrees that: (1) participant is physically fit and able to participate in the event; (2) if at any time participant does not feel capable of participating, participant will immediately stop and inform Birth Choice Center volunteer or representative; (3) participant has freely and voluntarily chosen to participant in the event; and (4) participant takes full responsibility for participant’s personal actions and will comply with all the laws, rules and instructions, including any written or oral rules and other instructions provided for the event.

Use of Personal Images & Features:  Participant understands, acknowledges and agrees that:  (1) Birth Choice Centers and/or its representatives may capture participant’s voice, image or words or may take participant’s photograph (still or moving film photography, video photography, live transmission or other reproduction of a likeness) related to the event; (2) Birth Choice Centers and/or it’s representatives may use, publish and/or distribute (electronically or otherwise) participant’s name, voice, image, words and photographs for any purposes as Birth Choice Centers deems appropriate in its sole discretion (e.g. advertising, promotional, informational or other publications or materials; websites; websites; social media; etc.); (3) such use, publication or distribution may subject participant to notoriety or publicity; and (4) participant waives any right to financial or other consideration or any kind related to participant’s name, voice, image, words and photographs.

Parent/Legal Guardian:  Participant represents that: (1) participant is 18 or older; or (2) participant has had a parent or legal guardian also execute this form and/or any related documents and accept full responsibility for all terms and conditions of this Consent, Acknowledgement and Release.

Signature: _____________________________________________________ Date:_______________________

Printed Name: _________________________________________________