Hold Harmless Agreement

Biocitizen Inc. Hold Harmless Agreement for Parents/Guardians of Minors

I (Parent/Guardian’s name) ______________, as the parent or guardian for (Child’s Name) _____________, do hereby grant my permission for my child to attend a program offered by Biocitizen, Inc. I understand that Biocitizen, Inc. does not provide any accident or medical insurance for my child. I understand that I am required to provide accident/medical insurance for my child and do so under the policy listed below. I agree that I am financially responsible for any and all medical expenses associated with my child’s participation in this program.

I understand that the activities associated with the programs include inherent risks of personal injury or harm to my child. I understand that, although my child will be under adult supervision at all times, notwithstanding any level or degree of supervision, accidents may occur which could result in physical injury or harm to my child. It is with the full understanding of the risks associated with these types of activities that I grant permission for my child to participate in the program to be conducted by Biocitizen, Inc., and I agree, on behalf of myself, my child, and our successors and assigns, to release, indemnify, and hold harmless, Biocitizen, Inc. and its, officers, agents and employees from any and all liability, damages and claims of any nature arising out of or in any way related to my child’s participation in this program of Biocitizen, Inc. Permission is granted for my child to participate, and I understand that by signing this form I am voluntarily and knowingly accepting responsibility for my child’s participation in the activity or program to be conducted by Biocitizen, Inc.

(NOTE: Your child will not be allowed to participate in our program unless your medical insurance provider and policy number is provided below.)

Medical Insurance Provider:________________________________________

Policy No._____________________________

I understand that the terms of this agreement are legally binding and certify that I have signed this agreement on my own free will after carefully reading and fully understanding it.

Parent or Guardian (please print) ___________________________________

Date ______________

Biocitizen Inc. Hold Harmless Agreement for Adults

I (Adult’s name) ______________, fully understand the activities associated with the programs conducted by Biocitizen, Inc. includes inherent risks which may result in personal injury. I understand that Biocitizen, Inc. does not provide any accident or medical insurance for me. I understand that I am required to provide accident/medical insurance for myself and do so under the policy listed below. I agree that I am financially responsible for any and all medical expenses associated with my participation in this program.

I understand that, notwithstanding any level or degree of supervision in the program, accidents may occur which may result in physical injury or harm. It is with the full understanding of the risks associated with these types of activities that I participate in the program to be conducted by Biocitizen, Inc., and I agree, on behalf of myself, and my successors and assigns, to release, indemnify, and hold harmless, Biocitizen, Inc., and its officers, agents and employees from any and all liability, damages and claims of any nature arising out of or in any way related to my participation in this program of Biocitizen, Inc. I understand that by signing this form I am voluntarily and knowingly accepting responsibility for my participation in the activity or program to be conducted by Biocitizen, Inc.

(NOTE: You will not be allowed to participate in our program unless your medical insurance provider and policy number is provided below.)

Medical Insurance Provider:______________________________________

Policy No._____________________________

I understand that the terms of this agreement are legally binding and certify that I have signed this agreement on my own free will after carefully reading and fully understanding it.

Name (please print) ___________________________________

Signature __________________________

Date ______________