CONSENT TO PARTICIPATE AND RELEASE OF LIABILITY

I, the undersigned, do hereby state that I wish to participate in activities sponsored by the organization known as the Kingdom of Avalon, an Ohio not~for-profit corporation (hereafter "KOA").

The KOA has rules, which govern and may restrict the activities in which I can participate. These rules include, but are not limited to: Trustee Constitution, Kingdom Constitutions, Kingdom Addendum, and Executive Counsel Rulings for combat and non-combat related activities.

The KOA makes no representations or claims as to the condition or safety of the land, structures or surroundings, whether or not owned, leased, operated or maintained by the KOA.

I understand that all activities are VOLUNTARY and that I do not have to participate unless I choose to do so. I understand that these activities are potentially dangerous or harmful to my person or property, and that by participating voluntarily accept and assume the risk of injury to myself or damage to my property.

I understand that the KOA does NOT provide any insurance coverage for my person or my property. I acknowledge that I am responsible for my safety and my own health care needs, and for the protection of my property.

In exchange for allowing me to participate in these KOA activities and events, I agree to release from liability, agree to indemnify, and hold harmless the KOA, and any KOA agent, officer or KOA employee acting within the scope of their duties, for any injury to my person or damage to my property.

This Release shall be binding upon myself, successors in interest, and/or any person(s) suing on my behalf.

I have read the statements in this document. I agree with its terms and have voluntarily signed it. I understand that this document is complete unto itself and that any oral promises or representations made to me concerning this document and/or its terms are not binding upon the KOA, its officers, agents and/or employees.

I, the undersigned, do hereby state that I have not altered or tampered in any way with the contents or wording of this contractual waiver.

I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT. I HAVE READ AND UNDERSTOOD THIS RELEASE AND I UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS MEANING AND SIGNIFICANCE.

Legal Nane (Print)___________________________ Legal Name (Sign) _________________________________

On _____________________ before me, (NOTARY) ___________________________________________________

personally appeared to me (or proved to me on the basis of satisfactory evidence, to be the citizen(s) whose name(s) is/are subscribed to within the instrument and acknowledged to me that he/she/they executed the same in his/her/their individual capacity(ies), and that his/her their signature(s) on the instrument, are the said person(s), or the entity upon behalf of which the citizen(s) acted, execute the instrument.

________________________________________________________ NOTARY SEAL
Notary's Signature