PLEASE READ CAREFULLY, THIS IS A LEGAL DOCUMENT

I have given permission for my minor child to participate in the Dempsey Centers Quality Cancer Care, Inc. (“Dempsey Centers”) Program called Healing Tree Space 2 Breathe Camp run by Camp Kieve (“the Program”) from August 22-August 25, 2023. I understand that the Program includes by way of example, the following activities, in addition to other standard Program social events, meals, and general organizational operations (collectively referred to as “Activity”):

IN CONSIDERATION and as a condition of my minor child (the “Minor”) being permitted to participate in the Program, including being transported to and participating in any Activity, the undersigned Parent or Guardian for himself/herself, and his/her personal representatives, agents, heirs, spouse, other parents or guardians of the Minor, and next of kin (“I”) represents and agrees to this Waiver, Release and Indemnification Agreement including the provisions below, as follows:

1. Knowledge of Dangers; Agreement to Notify of Unsafe Conditions. I understand and will instruct the Minor that participating in the Program may be DANGEROUS and involve RISK OF INJURY and/or DEATH and/or PROPERTY DAMAGE; regardless of all feasible safety measures that may be taken. I understand and will discuss with the Minor that falls, collisions, accidents or other unanticipated injuries may occur. Specific risks and dangers related to the Program, including travel to and participation in the Activity include and are not limited to the following injuries and occurrences: bruising, pulled muscles, broken or fractured bones, or otherwise disabled limbs, asthma Space 2 Breathe Camp Participation Includes – Outdoor Activities: ropes course, climbing, hiking and travel via car. Waterfront Activities: swimming, canoeing, and boating (life jackets required as determined by Kieve Wavus Education, Inc.). Run by Kieve Wavus Education, Inc. (“Kieve”) Physical address: 42 Kieve Road, Nobleboro, ME 04555 Mailing address: P.O. Box 169 Nobleboro, ME 04555 Telephone: 207-563-5172 attacks, emotional/mental distress, allergic reactions, severe illness, cuts, burns, blistering, sun burn, cold temperatures, unexpected lightning strike and damages or losses related to any of these types of occurrences.

2. Participant is Fit to Participate. I understand the nature of the adventure-based programming and the Minor’s experience and capabilities. The Minor is in good health and is qualified to participate in adventure-based programming. The Minor does not have any physical or mental condition which would make his/her presence or participation in adventure-based programming unsafe to the Minor or to other participants or spectators. The Minor will not be under the influence of any substance which would impair his/her ability to participate safely in adventure-based programming.

3. Release of claims and Agreement not to Sue. I agree on behalf of myself and the Minor, and anyone acting on either one of our behalves, to RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE, the Dempsey Centers including any affiliated or parent entity, subsidiaries, successors, agents, assigns, officers, directors, contractors, volunteers, employees and insurers (collectively, the “RELEASEES”) from any and all claims of any kind, or any personal injury, death, damage, loss or expense (including court costs and attorneys’ fees) of any kind or nature (each a “LIABILITY”) arising out of or related to this Agreement or the Minor’s participation in any way in the Program or the Activity, for any reason and under all circumstances. This Release of claims extends to any incident, damage or injury arising out of or related to transportation to and from the Program and each Activity. THIS LIABILITY RELEASE INCLUDES BUT IS NOT LIMITED TO ANY AND ALL CLAIMS BASED ON ALLEGED NEGLIGENCE BY THE RELEASEES.

4. Indemnification. I agree to indemnify, defend and hold harmless the Dempsey Centers, including all Releasees from any Liability arising out of or related to this Agreement or the Minor’s participation in the Program and any related Activity, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Releasees (each a “Claim”). In other words, I agree that if, despite this Agreement, I, or anyone on my behalf, or any third party, including the minor makes a Claim related to the Minor, for Liability against any of the Releasees, I will indemnify, defend and hold harmless each of the Releasees from any such Liability and/or Claim.

5. Authorization regarding medical treatment. In addition to any other claims that I am releasing, I specifically consent to treatment of the Minor in the event of an emergency or other incident in which the Minor, in the reasonable judgment of Dempsey Center personnel or any volunteer, sponsor, agent or representative requires medical care, and I, the Minor, and anyone acting on the Minor’s behalf, release any and all claims against Releasees regarding such treatment.

6. Severability. This Agreement represents the complete understanding between me and the Releasees regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any portion of this Agreement is held to be unenforceable, invalid or overly broad, I agree that the remaining terms and provisions of this Agreement will continue in full legal force and effect.

I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY AND INDEMNITY AGREEMENT AND I FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I AND MY MINOR CHILD HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING IT, WHETHER BY HAND OR BY ELECTRONIC SUBMISSION. I HAVE SIGNED THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY RELEASEES TO THE GREATEST EXTENT ALLOWED BY LAW, AND TO SERVE AS CONFIRMATION OF MY COMPLETE AND UNCONDITIONAL ACCEPTANCE OF THE TERMS, CONDITIONS AND PROVISIONS OF THIS WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT.

As Parent or duly authorized Guardian for the minor participant named below, I verify that I have authority to enter into this agreement on behalf of the Minor.