Agreement for Waiver, Release, Consent, Assumption of Risk and Indemnification

V O L C O M

Agreement for Waiver, Release, Consent, Assumption of Risk and Indemnification

READ BEFORE SIGNING : This document affects your legal rights. You should read it carefully. No person will be granted entry or participation in any event or activity without proper completion of this document.

PARTICIPANT RULES ( THE ‘RULES

·  A signed waiver must be on file before participating in a Volcom Sponsored or hosted event.

·  Participation in the event is at your own risk.

·  Report injuries to an official or management immediately.

·  Report any broken equipment, or unsafe conditions to an official or management immediately.

·  No reckless behavior.

·  No alcohol or controlled substances at the Event.

·  Follow all posted rules at the Event and follow all written and oral rules stated by Volcom or other persons officiating the event.

In consideration of being allowed to participate in any way in a Volcom, Inc.(hereafter “Volcom”) sponsored or hosted event (an “Event”), I, undersigned, acknowledge, appreciate and agree that the risk of injury from an Event or other activities at the Event is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and other personal discipline may reduce this risk, the reisk of great personal injury still exsits; and

1.  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF VOLCOM AND/OR ANY OF ITS EMPLOYEES, OFFICERS OR AGENTS, AND THEREFORE ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION WITH THE EVENT OR ACTIVITY; and

2.  I willingly agree to comply with all Rules and Conditions for partcipation. If I observe any hazard during my presence or participation in an Event, I will remove myself from participation and bring such hazard to the attention of the nearest Volcom employee, officer, agent or official. If I am an employee of Volcom, I agree to inform an officer as soon as possible; and

3.  I agree to defend, indemnify and hold Volcom and ______(the ‘Covered Entities’) harmless from and against any and all loss, liability and/or expenses allegedly resulting from any such loss, liability and/or expenses, including attorney’s fees and costs that may result for any reason; and

4.  I acknowledge that the Covered Entities do not provide accident, medical, liability, worker’s compensation insurance for Event participants. As a parent or guardian, I hereby consent to emergency treatment for my minor child as a result of an accident or injury during the Event. I further agree to pay and/or reimburse, as applicable, any and all costs incurred as a result of such treatment for myself or my minor child; and

5.  I agree to carefully inspect and satisfy myself that the Event areas and facilities are reasonably safe for their intended use; and

6.  I acknowledge that surfing, skateboarding and/or snowboarding in dangerous activity, and that if I am a participant or spectator at the Event, that I may be in danger of serious injury or even death; and

7.  I acknowledge and understand the Rules and Conditions.

Participant ______Print Name ______AGE ______

Participant Address ______City ______

Phone ______Email Address ______

Emergency Contact ______AGE ______

Relation with participant ______Phone ______

Event Name ______Location ______

( Please Circle Division Below)

GROM JUNIOR PRO-AM

(13 & UNDER) (14 – 16) (17-20)

FOR PARTICIPANTS UNDER THE AGE OF 18 AT THE TIME OF THE EVENT

I certify that I am the parent or legal guardian of the participant, and I accept and consent to all of the conditions and terms of this Agreement, and I am authorized to enter into this Agreement. I agree, for myself, my heirs, administrators, executers and assigns that I shall indemnify and hold the Covered Entities harmless from any and all claims, demands, actions, losses, liabilities and suits arising out of or attributable to the minor’s entry into or use in the Event/activity, EVEN IF ARISING OUT OF THE NGLIGENCE OF THE COVERED ENTITIES, to the fulles extent permitted by law. I further agree that I have explainded this Agreement to the minor participating in the Event.

Parent/Legal Guardian ______

Print Name ______Date ______