BLOCK PARTY LIABILITY WAIVER Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact Phone:(Required)Date(Required) MM slash DD slash YYYY Consent(Required) This consent serves as my signature that I have read, and agree to the terms of the agreement.GOOD KARMA BROADCASTING RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT -- READ BEFORE SIGNING -- In consideration for the permission granted to me, my children, and/or those in my legal custody to participate in activities, the undersigned acknowledges, appreciates, and agrees as follows: 1. The Activities I am about to engage in may involve a risk of serious bodily injury, including permanent disability, paralysis and/or death, which may be caused by my own actions or inactions, the actions or inactions of others participating in the Activities, the conditions in which the Activities take place, and/or the negligence of the “Releasees” named below. In addition, I fully understand that there may be other, additional risks either known or unknown to me, or not readily foreseeable at this time; 2. I knowingly and freely assume all such risks, and all responsibility for such risks, both known and unknown, even if arising from the negligence of the Releases named below, or others; 3. I willingly agree to comply with the stated and customary terms and conditions of participation in the Activities; 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, discharge, and covenant not to sue Good Karma Broadcasting, partners, agents, employees, volunteers and affiliates of each of these entities, and any other participants in the Activities (the “Releasees”), from any and all liability, claims, demands, losses, or damages related in any way to any injury, disability, death, loss, or damage to person or property incurred as a direct or indirect result of my involvement or participation in the Activities, including those caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, to the fullest extent permitted by law; 5. I, for myself and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby agree to indemnify and hold harmless all of the above Releasees from any and all liabilities, including any and all related claims by third parties, (including attorneys’ fees) related in any way to my involvement or participation in the Activities, even if arising from the negligence, to the fullest extent permitted by law; and 6. I hereby give my permission to Good Karma Broadcasting to use my name and any photographs or other likenesses of me, my children, and those in my legal custody, in connection with promotions of the event in which I/we participate or other events of Good Karma Broadcasting. I have read this Release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.
