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THIS ACTIVITY WAIVER & RELEASE

(this “Agreement”) dated this day of March 22, 2023 

BETWEEN:

The Undersigned (the “Participant”)

OF THE FIRST PART

AND

D31 of 6475 SE 33rd Way Gresham Oregon 97080 (the “Activity Provider”)

OF THE SECOND PART

IN CONSIDERATION OF the covenants and agreements contained in this Agreement and other good and valuable consideration, the receipt of which is hereby acknowledged, the parties to this Agreement agree as follows:

Consideration

Being of lawful age and in consideration of being permitted to participate in the activity described below, the Participant releases and forever discharges the Activity Provider, its owners, directors, officers, employees, agents, assigns, legal representatives and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant’s participation in the activity described below, and not withstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Activity Provider.

The Participant understands that the Participant would not be permitted to participate in the activity described below unless the Participant signed this Agreement.

Details of Activity

The Participant will participate in the following activity: Any activity or gathering promoted, hosted or sponsored by D31. Spectators are also considered participants.

Concurrent Release

The Participant acknowledges that this Agreement is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant and with the intention of binding the Participant’s spouse, heirs, executors, administrators, legal representatives and assigns.

Fitness to Participate

The Participant acknowledges that the Participant does not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent the Participant from participating in the above mentioned activity. If required, the Participant will obtain a medical examination and clearance.

Full and Final Settlement

The Participant hereby acknowledges and agrees that the Participant has carefully read this Agreement, that the Participant fully understands the same, and that the Participant is freely and voluntarily executing the same.

The Participant understands that by signing this Agreement, the Participant agrees to be forever prevented from suing or otherwise claiming against the Activity Provider for any property loss or personal injury that the Partic- ipant may sustain while participating in or preparing for the above noted activity.

The Participant has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this Agreement.

This Agreement contains the entire agreement between the parties to this Agreement and the terms of this Agreement are contractual and not a mere recital.

Governing Law

This Agreement will be governed by and construed in accordance with the laws of the State of Oregon. Emergency Contact

ELECTRONIC SUBMISSION

Participant acknowledges that by providing information in this electronic waiver and submitting by electronic delivery systems, all information and signatures bare the same authority as in person permissions. Where applicable, typed names substitute for signatures.

IN WITNESS WHEREOF the Participant and Activity Provider have duly affixed their signatures under hand and seal on this day of March 22, 2023.

 

PHOTO | MEDIA RELEASE FORM

BETWEEN: D31

AND: The Undersigned

(hereinafter called ‘the Photographer’ ) (hereinafter called ‘the Participant ‘) hereby acknowledged by the Model, both parties hereto agree as follows:

DESCRIPTION OF PHOTOGRAPHS. This Agreement applies to any and all photographs in any format, still, single, multiple, moving or video, (herein collectively called ‘the Photographs’) of the Participant and the Participant’s Property made by the Photographer on the session dates vand to all reproductions and modifications of such Photographs.

USE OF THE PHOTOGRAPHS. The Participant hereby consents to and authorizes the use of the Photographs by the Photographer and the Photographer’s authorized representatives, licensees, successors, and assigns for any purpose whatsoever including and without limitation: sale, reproduction in all media, publication, display, broadcast and exhibition for promotion, advertising, trade, art or illustration. The Participant agrees that the Photographs may be used without further compensation for an unlimited time and that this Agreement is irrevocable.

OWNERSHIP AND RIGHTS IN THE PHOTOGRAPHS. The Participant agrees that the Photographs, the copyright in the Photographs and all other rights in the Photographs or copies or reproductions thereof are the sole property of the Photographer and that the Photographer may protect the copyright or dispose of or authorize the use of any or all such rights in any manner whatsoever.

RELEASE OF PHOTOGRAPHER FROM LIABILITY. The Participant releases the Photographer and all other persons entitled under this Agreement to use the Photographs from all liability for libel, invasion of privacy, and all causes of action whatsoever in relation to the Photographs, their making and use, the Participant or the Participant’s property including without limitation any liability for alteration of the Photographs, whether intentional or otherwise, that may occur during the making or subsequent use of the Photographs.

The Participant understands English. The Participant acknowledges reading the entire Agreement in full and attentively prior to signing, and the Participant is perfectly familiar with its contents. This Agreement shall be binding upon the Participant’s heirs, legal representatives, and assigns.

CAPACITY.

If the Participant is an adult: I, the Participant, warrant and represent that I am not a minor, and do have the legal age or status in my country to sign this Agreement and I am 18 years of age or older on the Photographs session date(s).

If the Participant is a minor: PARENTAL AUTHORIZATION. I warrant and represent that I am the parent or guardian of the Participant above named. I understand English. I have read this authorization, release, and Agreement in full, prior to its execution, and I am perfectly familiar with its contents This Agreement shall be binding upon me and my heirs, legal representatives, and assigns.

Agreement Dated: March 22, 2023

LIABILITY WAIVER AND RELEASE OF CLAIMS:

I acknowledge that I derive personal satisfaction and a benefit by my participation and/ or voluntarism with D31, and I willingly engage in D31 events and/or other activities (the “Activity”).

RELEASE AND WAIVER.

I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST THE SYNERGY DESIGN FIRM AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE “RELEASED PARTIES”), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH I, MY HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON MY BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM MY PARTICIPATION WITH THE ACTIVITY.

ASSUMPTION OF THE RISK.

I acknowledge and understand the following:

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist;

2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Released Parties; and

3. I hereby knowingly assume the risk of injury, harm and loss associated with the Activity, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Released Parties.

MEDICAL ACKNOWLEDGMENT AND RELEASE

I acknowledge the health risks associated with the Activity, including but not limited to transient dizziness, lightheaded, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death. I agree that if I experience any of these or any other symptoms during the Activity, I will discontinue my participation immediately and seek appropriate medical attention. I DO HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASED PARTIES FROM ANY CLAIM WHATSOEVER WHICH ARISES OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY.

As a participant, volunteer, or attendee, You recognize that your participation, involvement and/or attendance at any D31-Bebold event or activity (“Activity”) is voluntary and may result in personal injury (including death) and/or property damage. By attending, observing or participating in the Activity, You acknowledge and assume all risks and dangers associated with your participation and/or attendance at the Activity, and You agree that: (a) D31-BeBold. (b) the property or site owner of the Activity, and (c) all past, present and future affiliates, successors, assigns, employees, volunteers, vendors, partners, directors, and officers, of such entities (subsections (a) through (c), collectively, the “Released Parties”), will not be responsible for any personal injury (including death), property damage, or other loss suffered as a result of your participation in, attendance at, and/ or observation of the Activity, regardless if any such injuries or losses are caused by the negligence of any of the Released Parties (collectively, the “Released Claims”). BY ATTENDING AND/OR PARTICIPATING IN THE ACTIVITY, YOU ARE DEEMED TO HAVE GIVEN A FULL RELEASE OF LIABILITY TO THE RELEASED PARTIES TO THE FULLEST EXTENT PERMITTED BY LAW.

Today's Date: March 22, 2023 


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contacts

Full Name *

Relationship *

Phone *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Emergency Medical Authorization Form 

Purpose: To enable parents or Guardians to authorize the provision of emergency medical treatment for children who become ill or injured while under D31 authority when parents or guardians cannot be reached. 



List of Medical Conditions

Allergic
Part 1
To GRANT consent

I hereby give consent for the following medical care providers and local hospital to be calledmww: 



Dr.

Phone

Dentist

Phone

Specialist

Phone
Part 2
To REFUSE consent

I do not give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, instead I wish for D31 to take the following action:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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