AGREEMENT AND RELEASE FROM LIABILITY

 PARTICIPATION IN ACTIVITY

 I/We, the ________________ Family, acknowledge that I/We have voluntarily applied to participate in the water slide party at _______________, hosted by Felix A. Gen, D.D.S., M. S., Inc. on August 12, 2007.  We also acknowledge that all children must be accompanied by an adult/guardian.

 ASSUMPTION OF RISK

 I/We am/are aware that water sports can be a hazardous activity.  I/We am/are voluntarily participating in these activities with knowledge of the hazards involved, hereby agree to accept any and all risks of injury and verify this statement by placing my/our initials here:__________________.

RELEASE

As consideration for being permitted by Felix A. Gen, D.D.S., M.S. to participate in these activities and use the facilities, I/we hereby agree that I/we, my/our assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue, or attach the property of Felix A. Gen, D.D.S., M.S. for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of Felix A. Gen, D.D.S., M.S., as a result of my participation in this event.  I/We hereby release Felix A. Gen, D.D.S., M.S. from all actions, claims, or demands that I/we, my/our assignees, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in this event.

 AGREEMENT FOR PHOTOGRAPHY

 I/We agree to be photographed during this party.  I/We agree to allow the display of these photographs with our name(s) in Dr. Felix Gen's website, newsletter and office until August 12, 2017. (10 years)

 KNOWING AND VOLUNTARY EXECUTION 

I/We have carefully read this Agreement and fully understand its contents.  I/We am/are aware that this is a release of liability and a contract between myself/ourselves and Felix A. Gen, D.D.S., M.S., and sign it of my/our own free will.

 PARENTAL RELEASE

I/We, the parents & the below listed participants, agree to be bounded by this Agreement and Release from Liability.

Parents          1)_____________________      2)__________________________

       &

Participants   3)_____________________       4)__________________________

                      5)_____________________     6)__________________________

PARENT’S SIGNATURE____________________________  Date_________________2007

 Guest Participants:                                 Parent’s Signature of Release:        

 1)___________________              ___________________________Date_______2007

2)___________________               ___________________________Date_______2007

3)___________________               ___________________________Date_______2007

4)____________________               ___________________________Date_______2007