Group Liability Form

COMMUNITY GROUP ACTIVITY RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNIFICATION AGREEMENT READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS. 1. ACTIVITIES AND ASSOCIATED RISKS: Community Group Activities (the “Activities”) offered by and through Cortica, Inc. (hereinafter referred to as “Cortica”) use experiential, engaging, teaching techniques which may entail certain risks, including but not limited to, falls, falling objects, fractures, concussions, etc. The undersigned hereby agrees and acknowledges that: a. while the staff of Cortica and Community Group facilities have been trained to protect emotional and physical safety, participation is purely voluntary; b. as a consequence of these risks and other risks associated with the Activities that may not be listed here, Participant may be seriously ill, hurt, disabled or may die from the resulting injuries, and/or my property may also be damaged; hospital facilities, qualified medical care, and emergency medical evacuation may be delayed, limited or unavailable during portions of the Activities; and c. Cortica assumes no responsibility for providing medical care during the Activities, and I will have to pay for any medical care and/or evacuation that I incur. In consideration of the permission to participate in the Activities, the undersigned agrees to the terms contained in this document and understand and acknowledge that programs offered by and through Cortica use experiential, engaging, teaching techniques. 2. ASSUMPTION OF THE RISKS: The undersigned hereby freely assumes the inherent risks as well as any other risks not listed that are part of these Activities, and any harm, injury, illness, or loss that may occur to me or Participant as a result of participation in the Activities or during any transportation to or from the Activities—including any injury, illness, or loss caused by the negligence of Cortica, its employees, agents and officers, its contractors, and other Activities participants. 3. RELEASE OF LIABILITY: The undersigned hereby RELEASE Cortica, its subsidiary, affiliated, controlled and related companies, successors and assigns and its employees, agents, officers, and contractors, the providers of any equipment used in the Activities, (“the Released Parties”) FROM ALL LIABILITIES, CAUSES OF ACTION, CLAIMS AND DEMANDS that arise in any way from any injury, illness, death, loss or harm that occur to me or to Participant or to any property during the Activities or in any way related to the Activities, including during transportation to or from the Activities. This RELEASE includes claims for the negligence of the Released Parties and claims for strict liability for abnormally dangerous activities. This RELEASE does not extend to claims that California law does not permit to be released by Agreement. I also agree NOT TO SUE or make a claim against the Released Parties for any bodily injury, psychological or emotional injury, personal injury, illness, death, property damage, loss or harm that may result during the Activities or are related in any way to the Activities whether caused by the negligence of Cortica or its officers, directors, employees or agents, or otherwise. Participant also understands Cortica does not assume any responsibility for or obligation to provide financial assistance