In consideration of permission granted by ANTHEM Coffee allowing me to participate
in (the "Activity"), which will occur on the date noted above:
1. I acknowledge that participating in the Activity involves certain risks (some of
which I may not fully appreciate) and that injuries, death, property damage or other harm could
occur to me or others. I accept and voluntarily incur all risks of any injuries, damages, or harm
which arise during or result from my participation in the Activity, including any associated
travel, regardless of whether or not caused in whole or in part by the negligence or other fault of ANTHEM and/or its or their departments,
trustees, affiliates, employees, officers, agents or insurers ("Released Parties").
2. I waive all claims against any of the Released Parties for any injuries, damages,
losses or claims, whether known and unknown, which arise during or result from my
participation in the Activity, regardless of whether or not caused in whole or part by the
negligence or other fault of any of the Released Parties. I release and forever discharge the
Released Parties from all such claims.
3. I agree to indemnify and hold the Released Parties harmless from all losses,
liabilities, damages, costs or expenses (including but not limited to reasonable attorneys' fees
and other litigation costs and expenses) incurred by any of the Released Parties as a result of
any claims or suits that I (or anyone claiming by, under or through me) may bring against any
of the Released Parties to recover any losses, liabilities, costs, damages, or expenses which
arise during or result from my participation in the Activity, regardless of whether or not caused
in whole or part by the negligence or other fault of any of the Released Parties.
4. I have carefully read and reviewed this Waiver, Release And Hold Harmless
Agreement. I understand it fully and I execute it voluntarily as I type my name in below: