Youth and Community Outreach Department Release of Liability Form: Adults and Minors

Parent/Guardian Name(s) (print)______________________________________________________________________ Parents Date(s) of Birth (same order)__________________________________________________________________ Address________________________________City_________________Zip____________Military Housing? Yes/No Email Address________________________________________Service Branch_____________________Rank______ Home Phone__________________________Work__________________________Cell__________________________ Emergency Contact________________________________________________________________________________ EC Home Phone_______________________EC Work_______________________EC Cell_______________________ Minor Children Participating: Name_____________________________________________________Date of Birth________________Gender______ Name_____________________________________________________Date of Birth________________Gender______ Activity or Group ASYMCA & Ernst & Young LLP Bike Giveaway Date(s) December 9, 2011

Location ASYMCA HQ 3293 Santo Road, San Diego CA 92124 (Santo Baseball Field)

I, the undersigned parent/person having legal custody/guardianship of the above said minor, give permission for the minor to participate in the San Diego Armed Services YMCA program described above. I hereby grant full permission for my child and/or myself to be photographed by the San Diego Armed Services YMCA staff for any legitimate purpose without payment or compensation. The minor is physically able and mentally prepared to participate in all activities as described in the announcement for the program. I hereby voluntarily and knowingly assume all risks and dangers inherent and incidental to the activities of the program. I will not hold the San Diego Armed Service YMCA liable for any injuries incurred during the program or while my child(ren) is/are in transit to and from the program whether caused by equipment or the act or omissions of others excepting damage or injury solely caused by the willful misconduct or negligence of the San Diego Armed Services YMCA, or its employees, volunteers, or agents. I do hereby authorize the San Diego Armed Services YMCA as agent for the undersigned, to consent with respect to the minors, to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the California Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that the San Diego Armed Services YMCA is not responsible for costs incurred for medical care. If I participate in the program, whether as coach, instructor, aide, spectator, or participant, I presently waive as to the San Diego Armed Services YMCA and staff, officers and directors thereof, any claim presently known or unknown for damage to property or personal injury whether caused by equipment or the acts or omissions of others including San Diego Armed Services YMCA personnel.

****Parent/Guardian (Signature)____________________________________Date___________________****

Release Use of Childs Name and Likeness I, ________________________________________________, am the legal parent or guardian of the minor child named below and I have the legal authority to execute this release on behalf of the child. I do hereby give Ernst & Young LLP (Ernst & Young) the irrevocable right to use the childs name, biographical information, picture, portrait, or photograph (Likenesses) in all forms and in all media without restriction as to changes or alterations (including but not restricted to composite or derivative works made in any medium) for promotion, exhibition or any other lawful purpose in connection with the Ernst & YoungArmed Forces YMCA childrens bike building event day in San Diego (the Event), and I waive any right to inspect or approve the photograph(s) or finished version(s) incorporating the photograph(s), including written copy that may be created and appear in connection therewith.

I hereby release and agree to hold harmless Ernst & Young and the photographer, __________________________, and their respective assigns, licensees, successors in interest, legal representatives and heirs from any liability arising out of use of the Likenesses, including but not limited to claims for either invasion of privacy or libel. I agree that Ernst & Young owns the copyright in these photographs and that Ernst & Young owns the usage rights to these photographs or works derived therefrom.

Disclaimer of Warranties I understand that the bicycle provided to my child in connection with the Event is provided AS IS AND THAT NEITHER ERNST & YOUNG NOR ANY OTHER PARTY INVOLVED IN THE CREATION, PRODUCTION OR DELIVERY OF THE BICYCLE MAKES, AND EACH EXPRESSLY DISCLAIMS, ANY WARRANTIES, EXPRESS OR IMPLIED, WITH RESPECT THERETO, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE OR USE. I hereby release and agree to hold harmless Ernst & Young and its personnel, partners and vendors and their respective assigns, successors in interest, legal representatives and heirs from any liability arising out of the use or possession of the bicycle.

I am of full age and competent to sign this release. I agree that this release shall be binding on me, my legal representatives, heirs, and assigns. I have read this release and am fully familiar with its contents. Name of Minor Child _____________________________ Signed_________________________________________ Address________________________________________ _____________________________________ Date__________________________________________