STUDENT RELEASE AND WAIVER OF LIABILITY FORM

This Release and Waiver of Liability (the “release”) is executed on the date shown below by the student named below (the “Student”), and releases Alzheimers Coachella Valley, non-profit corporation organized and existing under the laws of the State of California and each of its directors, officers, employees, and agents. As part of their school program, the student will engage in agency activities.

Student understands that the scope of Student’s relationship with Nonprofit is limited to a student position and that no compensation is expected in return for services provided by Student; that Nonprofit will not provide any benefits traditionally associated with employment to Student; and that Student is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of Student’s services to Nonprofit.

1. Waiver and Release: I, the Student, release and forever discharge and hold harmless Nonprofit and its successors and assigns from any and all liability, claims and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Nonprofit. I understand and acknowledge that this Release discharges Nonprofit from any liability or claim that I may have against Nonprofit with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services I provide to Nonprofit or occurring while I am providing student services.

2. Insurance: Further I understand that Nonprofit does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance. I expressly waive any such claim for compensation or liability on the part of Nonprofit beyond what may be offered freely by Nonprofit in the event of injury or medical expenses incurred by me.

3. Medical Treatment: I hereby Release and forever discharge Nonprofit from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a student with Nonprofit.

4. Assumption of Risk: I understand that the services I provide to nonprofit may include activities that may be hazardous to me including, but not limited to, lifting, food services, operating office equipment, or exercising involving inherently dangerous activities. As a student, I hereby expressly assume risk of injury or harm from these activities and Release Nonprofit from all liability.

5. Photographic Release: I grant and convey to Nonprofit all right, title and interests in any and all photographs, images, video or audio recordings of me or my likeness or voice made by Nonprofit in connection with my providing student services to Nonprofit.

6. Other: As a student, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of California and that this Release shall be governed by and interpreted in accordance with the laws of the State of California. I agree that in the event that provisions of the Release shall not be affected.

By signing below, I express my understanding and intent to enter into the Release and Waiver of Liability willingly and voluntarily.