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Fifth Annual Love Walk/Run Waiver and Release Form

In consideration for the opportunity to participate in the Fifth Annual Pacific Palisades Love Walk/Run (the Event), I agree as follows for myself, and for the child(ren) that is/are under my supervision who participate and/or attend with me:

1. I hereby waive and release, for myself, the child(ren) that is/are under my supervision, my heirs, executors and administrators, any and all rights, claims, liabilities and causes of action whatsoever I or the child(ren) that is/are under my supervision may have against the Pacific Palisades Womens Club and the Dr. Susan Love Research Foundation, their affiliates and the Event operators and sponsors and each of their respective officers, directors, employees and agents (the Event Parties) relating to or arising from my or the child(ren) that is/are under my supervision participation in the Event, including but not limited to personal injury.

2. I recognize the Event on Sunday, May 20, 2012 has inherent risk of injury and I hereby assume that risk, and on behalf of me and the child(ren) that is/are under my supervision. If I, the child(ren) that is/are under my supervision, or pet (animal) causes injury to any person or damage to any property while participating in the Event, I hereby indemnify and hold harmless the Event Parties from and against any and all claims, suits, actions, losses, damages, and expenses related to or arising from such injury or damage.

3. I understand that I am solely responsible for the health and safety of myself and the children that are under my supervision at the Event. I am certain that I and the children that are under my supervision are physically capable of participating with the Event. I understand that any physical activityincluding the physical activity involved with my participation with the Eventhas inherent risk of injury and I assume that risk on behalf of me and the children that are under my supervision during the Event.

4. I hereby give my consent to the Pacific Palisades Womens Club and the Dr. Susan Love Research Foundation and their affiliates to use my and the child(ren) that is/are under my supervision name(s) and photographs, video and film (photos) of me and/or the child(ren) that is/are under my supervision taken before, during or after the Event in advertising and promotional materials for the Pacific Palisades Womens Club and the Dr. Susan Love Research Foundation, including but not limited to the internet,

without compensation. I agree that no advertising or other materials need be submitted to me or the child(ren) that is/are under my supervision for approval. I agree that all Photos of me and/or the child(ren) that is/are under my supervision used by the Pacific Palisades Womens Club and the Dr. Susan Love Research Foundation and their affiliates are owned by the Pacific Palisades Womens Club and the Dr. Susan Love Research Foundation and may copyright material containing the same. I hereby release, discharge, and agree to save harmless the Event Parties from any liability, including, without limitation, any claims for libel or invasion of publicity/privacy, by virtue of any use of my or the child(ren) that is/are under my supervision name and/or Photos, including, any alteration of such Photos, whether intentional or otherwise.

I have read and understand the Waiver and Release, and declare all information is truthful and accurate.