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MIDDLE GROUND LIGHT LLC

RELEASE, WAIVER AND ASSUMPTION OF RISK


By execution of this Release, Waiver of Liability, and Assumption of Risk (the "Release"), the undersigned (on
my own behalf and on behalf of my heirs, personal representatives, successors and assigns), for and in consideration of the
opportunity to tour, board, visit, volunteer, work on or otherwise gain entry to the Newport News Middle Ground
Lighthouse (the "Lighthouse"), owned by Middle Ground Light LLC, holds harmless Middle Ground Light, LLC, any
and all affiliated entities, and its officers, directors, employees and agents, family members of any of the preceding, thereof
(hereinafter referred to collectively as "Middle Ground"), from any and all claims and demands, rights and causes of
action of any kind whatsoever which I now have or later may have against Middle Ground in any way resulting from,
arising out of, or in connection with participating in any activity on or associated with the Lighthouse. I am voluntarily
participating in such activities and I hereby assume the entire risk of any accidents or personal injury, including death,
which I may sustain to my person or property at any time as a result of my participation in such activities. I understand
and accept that participating in activities on or associated with the lighthouse entails certain inherent risks to property,
personal injury and potentially loss of life.
This Release and Waiver of Liability extends to any and all claims I have or later may have against Middle
Ground resulting from or arising out of my participation in any activity on or associated with the Lighthouse, whether such
claims result from negligence on the part of Middle Ground with respect to the Lighthouse, or any other legal theory. I
UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE MIDDLE GROUND FOR ANY INJURY
RESULTING TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH, MY
PARTICIPATION IN ANY ACTIVITY ON OR ASSOCIATED WITH THE LIGHTHOUSE.
I understand that any person under the age of eighteen (18) must be accompanied by a parent or legal guardian in
order to participate in any activity on or associated with the Lighthouse. By signing this Release, I warrant that if I am the
parent or legal guardian of any person under the age of eighteen (18) who participates in an activity on or associated with
the Lighthouse, I will accompany said person(s) at all times during their participation.
I FURTHER AGREE TO WAIVE ALL BENEFITS FLOWING FROM ANY STATE STATUTE WHICH
WOULD NEGATE OR LIMIT THE SCOPE OF THIS RELEASE. I agree that the laws of the Commonwealth of
Virginia, without regard to principals governing choice or conflicts of laws, shall govern the rights and obligations of the
parties involved in this Release. In the event any portion of this Release is found to be unenforceable, the remaining terms
shall be fully enforceable.
I have read this Release. I understand that by signing it, I give up substantial rights I might otherwise have to
recover damages for losses or injury, even if Middle Ground is at fault, and I am signing voluntarily and without
inducement.
I represent and warrant that I have the authority to give this Release. If the participant is a minor, I am the parent
or guardian of the minor listed on the same line as my signature and on the minor's behalf and on my behalf and on
behalf of all other parents or guardians of the minor, I accept the Release as inducement for allowing my child, or
this minor, to participate in activities on or associated with the Lighthouse, pursuant to the terms of this Release.

Signature
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Printed Name
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Parent or guardian of Phone


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THIS FORM MUST BE SIGNED AND RETURNED TO PARTICIPATE

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