Accident Waiver and Release of Liability Form

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY RELEASE AND FOREVER DISCHARGE AND AGREE TO SAVE AND HOLD HARMLESS THE PHILIPPINE COMMISSION ON WOMEN, THEIR OFFICIALS, BOARD MEMBERS, EMPLOYEES, REPRESENTATIVES OR ASSIGNS AND THE ACTIVITY OR EVENT SPONSORS, AND EVENT ORGANIZERS, AND GUINNESS WORLD RECORDS ANY AND ALL INJURIES (INCLUDING PERSONAL INJURY, DISABILITY, DISMEMBERMENT, AND DEATH), ILLNESS, LOSSES, DAMAGES, CLAIMS, LIABILITIES OR EXPENSES OF ANY KIND OR NATURE ACCRUING TO ME, MY HEIRS OR MY PERSONAL REPRESENTATIVES THAT ARE CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY MY ACTION, FAULT, OMISSION, FAILURE TO ACT, OR BY MY BREACH OR ALLEGED BREACH OF THIS WAIVER AND RELEASE, OR BY THE CONDITION OF THE PROPERTY, FACILITIES OR EQUIPMENT OF ANY RELEASED PARTY OR THAT ARISE OUT OF OR IN CONNECTION WITH THE EVENT OR MY PARTICIPATION IN THE SULONG JUANA WOMEN’S SYMBOL FORMATION.

THIS ACCIDENT WAIVER AND RELEASE OF LIABILITY SHALL BE CONSTRUED BROADLY TO PROVIDE A RELEASE AND WAIVER TO THE MAXIMUM EXTENT PERMISSIBLE UNDER APPLICABLE LAW.

- RELEASE AND AUTHORIZATION-

I HEREBY IRREVOCABLY AND PERPETUALLY PERMIT AND AUTHORIZE THE COCA-COLA COMPANY (TCCC), THE COCA-COLA EXPORT CORPORATION-PHILIPPINES BRANCH (TCCEC), ITS SUBSIDIARIES, AFFILIATES AND BOTTLERS, THEIR RESPECTIVE SUCCESSORS, ASSIGNS AND THOSE ACTING UNDER THEIR PERMISSION TO DISPLAY IN ANY TYPE OF ELECTRONIC OR DIGITAL MEDIA THROUGHOUT THE WORLD, USE, BROADCAST, PUBLISH AND COPYRIGHT FOR ADVERTISING, PROMOTION, PUBLICITY, PACKAGING, PUBLIC RELATIONS AND MEDIA PURPOSES AND FOR ANY OTHER LAWFUL PURPOSES WHATSOEVER, THE NAME, IMAGE, PICTURE, VIDEO, STATEMENTS, RECORDINGS OR INTERVIEWS, ENDORSEMENTS AND ANY OTHER INFORMATION ABOUT OR RELATED TO SULONG JUANA HUMAN WOMEN'S SYMBOL FORMATION, AS WELL AS MY NAME AND IMAGE, BIOGRAPHICAL INFORMATION, VOICE, STATEMENTS, RECORDINGS OR INTERVIEWS AND ENDORSEMENTS MADE BY OR ATTRIBUTABLE TO ME, VERBATIM OR OTHERWISE, PHOTOGRAPHIC PORTRAITS, DRAWINGS, VISUAL REPRESENTATIONS, VIDEO TAPES, MOTION PICTURES OR OTHER USE OF MY LIKENESS IN WHOLE OR IN PART, AND ANY REPRODUCTIONS THEREOF, IN ALL MEDIA NOW KNOWN OR HEREAFTER DEVELOPED WORLDWIDE WITHOUT LIMITATION, IN CONNECTION WITH MY PARTICIPATION IN THE EVENT.

I HEREBY WARRANT THAT IF A PHOTO/PICTURE OF THE EVENT INCLUDES AN IMAGE OF ANY PERSON, I HAVE THE PERMISSION OF EACH PERSON PICTURED TO ALLOW HIS/HER IMAGE TO BE USED BY US AS DESCRIBED ABOVE.

I HEREBY RELEASE AND DISCHARGE THE LICENSED PARTIES FROM ANY LIABILITY WHATSOEVER, INCLUDING WITHOUT LIMITATION CLAIMS FOR INVASION OF PRIVACY, DEFAMATION OF CHARACTER OR ANY ALTERATION, DISTORTION OR ILLUSIONARY EFFECT, WHETHER INTENTIONAL OR OTHERWISE, IN CONNECTION WITH SAID USE. I DO HEREBY WAIVE ANY RIGHT THAT I MAY HAVE TO INSPECT OR APPROVE THE FINISHED PRODUCT OR ANY MATERIAL THAT MAY BE USED IN CONNECTION THEREWITH OR THE USE TO WHICH IT MAY BE APPLIED.

I REPRESENT AND WARRANT THAT I AM AUTHORIZED TO ENTER INTO THIS RELEASE AND THAT I HAVE OBTAINED OR DO NOT REQUIRE THE CONSENT OF ANY THIRD PARTY TO ENTER INTO THIS RELEASE.

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ORGANIZATION NAME:

COORDINATOR:

DATE:

NAMES OF THE PARTICIPANTS

(NAME OF AGENCY HEAD)

SIGNATURE

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