CONSENT, WAIVER AND RELEASE

I, the undersigned, will be participating in events and activities (hereafter the “activities”) with Midwest Anxiety, LLC.

I recognize that there are risks involved in the activities and hereby assume all risk of injury, harm, damage, or death in connection with my participation in the activities. I understand and agree that neither Midwest Anxiety, LLC nor its trustees, officers, directors, employees, agents, or representatives may be held liable in any way for any injury, harm, damage, or death that may occur to me as a result of my participation in the activities and hereby release Midwest Anxiety, LLC, its Board of Directors, employees, agents and representatives from any injury, harm, damage, or death which may occur while I am participating in the activities. To the fullest extent permitted by law, I agree to save and hold harmless Midwest Anxiety, LLC, its trustees, directors, employees, agents and representatives from any claim by myself, my estate, heirs, successors, assigns or other persons arising out of my participation in the activities

I authorize Midwest Anxiety through its trustees, officers, directors, employees, agents or representatives to render or obtain such emergency medical care or treatment for me as may be necessary should any injury, harm or accident occur to me while participating in the activities.

I understand and acknowledge that Midwest Anxiety, LLC does not provide health or medical insurance in connection with the activities and I agree that I will be financially responsible for any bills incurred as a result of medical treatment, including emergency medical treatment and/or transportation to a medical facility, in connection with my participation in the activities.

I grant to Midwest Anxiety, LLC and its employees, officers, agents and assigns the right to use, reproduce, adopt, distribute, and publish photographs, video, audio or related content (“Content”) taken by Midwest Anxiety, LLC that are the subject of this agreement for the sole purpose of advertising and promoting Midwest through testimonial video blogs and other methods.

I understand and agree that the Content(s) may be used in whole or in part, at any time, in composite or distorted form, in color or otherwise and may be published through any medium including, but not limited to, printed medium, video and/or on the internet.

I waive any right to inspect or approve any finished product, advertising or other copy that that uses the Content.

I agree to indemnify Midwest Anxiety, LLC from and against any claims, losses, judgments, settlements, expenses and reasonable legal fees, incurred by Midwest Anxiety, LLC by reason of any claim, including but not limited to claims of invasion of privacy or trespass created in the taking or publication of the Content(s).  I also agree to indemnify Midwest Anxiety, LLC for any such amounts arising from my breach of any covenant, representation, or warranty of this agreement.

I understand that the terms herein are contractual and not a mere recital, that this instrument is legally binding, and that I have voluntarily signed this document.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS HEREIN BY READING IT BEFORE SIGNING IT ON BEHALF OF MYSELF AND MY HEIRS.

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