Waiver-Release

In consideration of the risk of injury while participating in COW Program activities (the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my or my relatives or assigns participation in the Activity, and do hereby release and forever discharge VMI and/or The College Orientation Workshop, Inc., located at P.O. Box 1047, Lexington, VA 24450, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any injury, pain, suffering, illness, economic or emotional loss, or death associated with participation in the aforementioned Activity, including traveling to and from an event related to the Activity.

I, Participant First Name* Participant Last Name* , and/or my minor relative or ward are voluntarily participating in the aforementioned Activity and I/we are participating in the Activity entirely at our own risk. I am aware of the risks associated with traveling to and from, as well as participating in this Activity. I understand that injuries may result from my own or others negligence, or conditions. Nonetheless, I assume all related risks, known and unknown to me and/or my minor relative or ward, in participation in this Activity.

I agree to indemnify and hold harmless VMI and/or The College Orientation Workshop, Inc. (COW) against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf. If VMI and/or The College Orientation Workshop (COW) incurs any expense associated with actions against it brought by me or anyone on my behalf or that of my minor relative or ward, I agree to reimburse VMI and/or COW, Inc.

I acknowledge that VMI and/or The College Orientation Workshop (COW) and its directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of VMI and/or COW.

I acknowledge that I have carefully read this "waiver and release" and fully understand that it is a release of liability. I expressly agree to release and discharge VMI and/or COW and all of its affiliates, managers, members, agents, volunteers and anyone else working on behalf of COW.

To the extent that statue or case law does not prohibit releases for negligence, this release is also for negligence on the part of VMI and/or COW, its agents, employees, and representatives. In the event that I or my minor relative or ward should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware that I should carry my own health insurance for myself and my minor relative or ward.

In the event that any damage to equipment or facilities occurs as a result of me or my minor relative/ward's willful actions, neglect, or recklessness, I acknowledge and agree to be held liable for any and all costs associated with that action.

In the event that any provision contained within this Release of Liability shall be deemed to be servable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties.

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Emergency Contact Relationship*

Alternate Emergency Contact

First NameLast Name

Alternate Emergency Contact Phone Number

Please enter a valid phone number.

Alternate Emergency Contact Relationship

In addition to the above, permission is granted to administer appropriate tests and assessments relating to learning styles, personality traits, leadership attributes, etc., and to use appropriate application information, pictures, video and/or audio recordings of me/my likeness, and/or my minor relative(s) in COW-related material. COW-related material may include news reports, program summaries, newsletters, surveys, social media communications, and any other appropriate use on behalf of the program. No sensitive personal information will be disclosed outside of VMI/COW.

I, the undersigned participant or participant`s parent or guardian, affirm that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content, and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.

Participant's Signature*

Participant's Email*

example@example.com

Participant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Participant's Age (as of today)*

Under 18 years oldOver 18 years old

(if participant is less than 18 years of age, a parent or guardian must also sign)

I certify that I am the parent or guardian of , named above, and do hereby give my consent without reservations to the foregoing on behalf of this individual.

Parent or Guardian's Name*

First NameLast Name

Relationship to Minor*

Parent or Guardian Signature*

Date*

Waiver and Release of Liability

Emergency Contacts