CONSENT & ACCIDENT WAIVER & RELEASE OF LIABILITY FORM FOR LAUREL HOUSE WAM EVENT

I HEREBY UNDERSTAND AND ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THE LAUREL HOUSE WALK A MILE IN HER SHOES® EVENT (the “Event”).

In consideration of permitting me to participate in the Event, I hereby, for myself and for each of my executors, administrators, heirs, next of kin, successors, and assigns WAIVE, RELEASE, HOLD HARMLESS, PROMISE NOT TO SUE, AND DISCHARGE the Released Persons (as defined below) from any and all liability, including, but not limited to liability arising, directly or indirectly, from the negligence or fault of any of the Released Persons, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me in connection with the Event. “Released Persons” shall include Laurel House; Pfizer Inc.; any sponsor of the Event; any volunteer assisting with the Event; and/or any affiliate, director, officer, employee, representative or agent of any of the foregoing entities or persons. I certify that I am physically fit, have sufficiently prepared or trained for participation in the Event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in the Event.

I understand while participating in this activity, I may be photographed. I hereby irrevocably provide my consent and agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the Laurel House, Pfizer Inc., and any producers, sponsors, organizers of the Event and the successors or assigns of any of the foregoing entities. The waiver and release and other agreements I have made herein shall be construed

broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

By signing this Consent & Accident Waiver & Release of Liability Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. I will not, at any time in the future, claim that my electronic signature is not legally binding. I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.