Please read the following and indicate whether you accept the terms below, or if 16 or under have a parent or guardian complete and confirm:

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IN CONSIDERATION of the rights of the individual whose name is printed below (the “Participant”) to participate in the basketball game(s), event(s) and other activit(y/ies) scheduled to take place in connection with Charity Bounce (collectively, the “Events”), I hereby, (a) give permission for the Participant to participate in the Events and (b) on behalf of myself, the Participant and our respective personal representatives, heirs and next of kin:

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1. Grant permission to the Released Entities (as defined below) to utilize Participant’s name, voice, statements, photograph, image, likeness, actions at the Events and/or Participant’s biographical data in any live or recorded form (including, but not limited to, any form of video display or other transmission or reproduction), in whole or in part, for promotional, commercial or any other purpose, in perpetuity worldwide in any media whether now known or hereafter created without any additional consideration;

2. (a) acknowledge that the Participant’s participation in the Events involves risk of serious bodily injury, death, property damage and/or other harm which might result not only from the Participant’s actions, inactions, or negligence, but also from the actions, inactions or negligence of others, the conditions of the premises or of any equipment used and that there may be other risks not known or reasonably foreseeable at this time; and (b) accept sole responsibility for all of the hazards and risks to Participant and Participant’s property associated with or related to Participant’s participation in the Events and for any damage or injury that Participant may cause to others;

3. (a) Release, waive and forever discharge any and all claims of damages or causes of action, including but not limited to, death, personal injury or loss or damage to property, which I, the Participant or any of the Participant’s representatives, heirs, next of kin or assignees (“Participant’s Representatives”) may have or which may hereinafter accrue to me, the Participant or Participant’s Representatives as a result of the Participant’s participation in the Events or otherwise and which may be asserted by me, the Participant, or Participant’s Representatives against Charity Bounce, its partners, sponsors, respective affiliates, administrators, agents, coaches, officers, directors and employees, other participants, sponsoring agencies, advertisers, and if applicable, owners and lessees of premises used in connection with the Events (collectively, the “Released Entities”), whether caused by the acts, omissions or negligence of the Released Entities or by any other person or entity and (b) agree to indemnify and save and hold harmless the Released Entities and each of them from any loss, liability, damage or cost they may incur due to my participation in or otherwise in connection with the Events, whether caused by the negligence of any of the Released Entities or otherwise;

4. Acknowledge that the Released Entities are relying on the grant of rights contained herein; and

5. Expressly agree that this Permission and Release Form is intended to be as broad and inclusive as is permitted by all applicable laws and that if any portion hereof is held invalid, it is agreed that the balance shall nonetheless continue in full legal force and effect.

I HAVE READ AND VOLUNTARILY SIGN THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agree that no oral representations, statements or inducement contrary to anything contained herein have been made by Charity Bounce or any of its employees or agents.