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Activity Waiver and Release of Liability <br />(Participant), in consideration of my <br />being permitted to participate in <br />on this date, do hereby release and forever discharge the property, its owner, and the <br />Historic Preservation Commission of South Bend and St. Joseph County, their officers, <br />directors, agents, employees, and assigns (collectively, the "Released Parties") from :any <br />and all claims, demands, causes of actions, suits, damages costs and expenses f6r any and <br />all personal injuries, loss of time, pain and suffering or property damage arising out of or <br />occurring in connection with the above activity. <br />I recognize and acknowledge that my participation in this activity is solely at my own <br />risk. I further understand that this Waiver and Release is absolute as to all claims, <br />demands, causes of actions, suits, damages, costs and expenses which may arise as a <br />result of my injury or demise or as a result of any property damage which could occur. - <br />I further agree to abide by all the rules and regulations as hereinafter amended or <br />supplemented, established by any of the Released Parties, and agree that my use of the <br />Premises may be canceled at any time, without prior notice or -warning and that I disclaim <br />any recourse in the event of such cancellation and agree to immediately vacate the <br />Premises upon request. <br />I have read and fully understand this document, including the fact that I am releasing and <br />waiving certain potential rights held by me and voluntarily and freely agree to the terms <br />and conditions set forth. <br />Signed this day of 2012. <br />Participant Signature <br />Printed Name of Participant <br />Witness Signature <br />V <br />