The undersigned is the parent or legal guardian of (the “Participant”) and acknowledges the Participant is
under age 18 and desires to engage in a dream experience fulfillment activity (the “Activity”) of Believe in Dreams® (the
The undersigned further acknowledges that the Organization and its affiliates and assigns, and each of their directors, officers,
employees and agents and any of its or their respective heirs, executors, personal representatives and administrators,
successors and assigns (collectively, the “Releases”) may wish to publicize the name, likeness and other personal characteristics
and private information of the Participant for advertising, promotion and other commercial, business, and charitable purposes.
In exchange for the intangible value the Participant will gain by possibility of participating in the Activity and other good and
valuable consideration, the undersigned gives, on behalf of the Participant, permission for such use and publicity for such
purposes, according to the terms and conditions set forth in this Liability and Publicity Waiver and Release.
The undersigned, on behalf of the Participant, hereby irrevocably permits, authorizes and licenses the Releases to display,
publicly perform, exhibit, transmit, broadcast, reproduce, exploit, sell, rent, license, otherwise use and permit others to use the
Participant’s personal biographical information and other personal characteristics and private information set forth in this
Application and all materials created by the Releases that use any of the foregoing (collectively, the “Materials”) on a perpetual
basis throughout the world and in any medium or format whatsoever now existing or hereafter created, including, without
limitation, brochure and other print publications, advertising and other promotional materials, and the internet and for any
purpose, including, without limitation, advertising, public relations, publicity, packaging and promotion of the Organization and
its operations and charitable purposes without further consent from or royalty, payment or other compensation to the
undersigned or the Participant.
The undersigned also acknowledges and agrees that the Participant assumes full responsibility for any and all risks of bodily
injury, death, disability, and/or property damage as a result of participating in the Activity. The signature below indicates the
undersigned understands any and all risks involved in participating in the Activity and willingly and voluntarily accepts any and
all such risks on behalf of the Participant. By executing this release, the undersigned, on behalf of the Participant, releases the
Releases from any and all claims, actions, suits, causes of action, damages (direct, indirect or consequential), entitlements to
money or other property, accounts, covenants, agreements, representations (express or implied), express or implied warranties,
judgments, losses, liabilities and obligations of every kind whatsoever, in law or in equity, however arising, known and unknown,
expected or unexpected, including any and all attorneys’ fees and other expenses incurred in connection therewith which the
undersigned and/or the Participant now has, ever has had, or may incur or have against the Releases based upon, or arising out
of, or relating in any way to the Activity and/or the Releases’ use of the Materials.
The undersigned acknowledges that he/she fully understands the consequences of signing this release and that, by signing this
release, neither the undersigned nor the Participant is entitled to be compensated or otherwise reimbursed by the Releases for
any damages that may be incurred as a result of the Activity and/or the Releases’ use of the Materials.
The provisions contained herein shall be binding upon the undersigned and the Participant and his/her heirs, executors,
personal representatives and administrators, successors and assigns and shall inure to the benefit of the Releases.
This Liability and Publicity Waiver and Release and the construction and interpretation of the provisions hereof shall be
governed by the laws of the State of Ohio.
THIS LIABILITY AND PUBLICITY WAIVER AND RELEASE PROVIDES THE RELEASEES WITH AN ABSOLUTE AND
UNCONDITIONAL CONSENT, WAIVER AND RELEASE OF LIABILITY, ALLOWING THE RELEASEES TO PUBLICIZE
AND USE THE LIKENESS AND OTHER PERSONAL CHARACTERISTICS AND PRIVATE INFORMATION OF THE
PARTICIPANT AS SET OUT ABOVE. BY SIGNING, YOU ACKNOWLEDGE THAT YOU HAVE READ AND
UNDERSTOOD ALL OF THE TERMS OF THIS WAIVER AND RELEASE AND THAT THE PARTICIPANT IS GIVING
UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE RELEASEES.