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Waiver, Indemnity, and Image Consent for Noble Research Institute




I wish to participate in an event hosted by Noble Research Institute, LLC (“Institute”). I understand that in exchange for my participation in the event, the Institute requires that I agree to this Waiver, Indemnity and Image Consent. I understand and agree to the following:

I agree that I will not bring any legal action of any nature against the Institute or its manager, agents, employees, or representatives (collectively, “Representatives”) as a result of, in connection with, or arising from my participation in the event, including, without limitation, any and all claims which may be based upon negligence by the Institute. Furthermore, I agree to indemnify and hold harmless the Institute and its Representatives from any loss, claim, expense (including attorneys’ fees), damage, demand, or cause of action of any kind or character that could be asserted by me, my family, my employer, or any other person, firm or entity as a result of, in connection with, or arising from my participation in the event. This agreement shall be construed to be as comprehensive as is allowed by law, as severable, and the invalidity of any provision of which shall not affect the validity of any other provision.

I further grant the Institute absolute and irrevocable permission, without any form of compensation in return, to record and/or reproduce my name, image, likeness, photograph, appearance, and voice (collectively “Images”) during the event.

I acknowledge all rights, title, and interests to my recorded and/or reproduced Images made during the event belong solely to the Institute, and my Images may be copyrighted and used by the Institute, in whole or in part, alone or with other media content, for any of its educational, scientific, informational, promotional, or institutional purposes, including but not limited to, fundraising efforts. I waive the right to inspect or approve any final product using my Images.

I release the Institute and its Representatives from all liability, damages, demands, or claims arising from the use of my Images and/or related to further dissemination of my Images outside control of the Institute.

I am signing this Waiver, Indemnity, and Image Consent to induce the Institute to allow my participation in the activity described above for my convenience. I understand this Waiver, Indemnity, and Image Consent and would not sign it if I did not. 



Reason for visit:
What brings you to Noble Research Institute?*
First Adult Participant's Name

First Name*

Last Name*
First Adult Participant's Age Acknowledgment*
First Adult Participant's Date of Birth*
I certify that I am 18 years of age or older
First Adult Participant's Signature*
Second Adult Participant's Name

First Name*

Last Name*
Second Adult Participant's Date of Birth*
Third Adult Participant's Name

First Name*

Last Name*
Third Adult Participant's Date of Birth*
Fourth Adult Participant's Name

First Name*

Last Name*
Fourth Adult Participant's Date of Birth*
Fifth Adult Participant's Name

First Name*

Last Name*
Fifth Adult Participant's Date of Birth*
Sixth Adult Participant's Name

First Name*

Last Name*
Sixth Adult Participant's Date of Birth*
Seventh Adult Participant's Name

First Name*

Last Name*
Seventh Adult Participant's Date of Birth*
Eighth Adult Participant's Name

First Name*

Last Name*
Eighth Adult Participant's Date of Birth*
Ninth Adult Participant's Name

First Name*

Last Name*
Ninth Adult Participant's Date of Birth*
Tenth Adult Participant's Name

First Name*

Last Name*
Tenth Adult Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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