(Please read carefully)

This Release, Waiver and Indemnification Agreement is made by and between the undersigned (the Athlete) and Jasper Blake Incorporated (the Company) and entered into the day, month and year below.

I am participating in a program including but not limited to a training and competitive athletic program (the Program). I represent that I am in good physical condition and/or have informed the Company of all existing medical conditions, injuries past and present, and other physical aliments, including suspected pregnancy. I hereby affirm that I have and will keep the Company fully informed of any physical condition or disability that would prevent or limit my participation in this Program.

I fully understand that I may injure myself as a result of my participation in the Program.

In consideration of my acceptance for participation in the Program, I agree that I am participating at my own risk. I, for myself, my heirs, executors, administrators and assigns, hereby release the Company, its servants, agents and employees from any claims, demands, actions or causes of action arising out of or in consequence of any loss, injury or damage to my person or property incurred while attending at or participating in a program of the Company, notwithstanding that any such loss, injury or damage may have arisen by reason of the negligence of Company, its servants, agents or employees.

I hereby affirm that I have read and understood the above.

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