MemberAgreement

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Waiver of Liability, Assumption of Risk, and Indemnity Agreement

SkullSpace Winnipeg Inc

Participant's name______________________________ Participant's Age (if minor) ______

Waiver: In consideration of being permitted to participate in any way in use of the SkullSpace Winnipeg Inc located at 125 Adelaide Ave, Winnipeg, Manitoba, Canada (hereinafter called "SkullSpace"), I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue the board of directors (hereinafter called "the board") from liability from any and all claims including the negligence of SkullSpace resulting in personal injury, accidents or illnesses (including death and property loss arising from, but not limited to, participation in SkullSpace.

________________________ ________ _____________________________________ _______

Signature of Participant Date Signature of Parent/Guardian of Minor Date

Assumption of Risks: Participation in SkullSpace carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from but are not limited to 1) minor injuries such as scratches,bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3)catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in SkullSpace I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD SkullSpace HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees brought as a result of my involvement in SkullSpace and to reimburse them for any such expenses incurred.

Damages: I understand that payment for damages is my direct responsibility. I agree to pay any estimated financial loss, subject to final adjustment.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the Province of Manitoba and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

________________________ ________ _____________________________________ _______

Signature of Participant Date Signature of Parent/Guardian of Minor Date