I acknowledge that by checking this box I agree the following terms and conditions shall govern my participation in Healing with Basketball (the "Clinic"), sponsored by The George Washington University Cancer Institute of The George Washington University ("GW"). I am aware that some Clinic activities I may participate in may involve risks of bodily injury, property damage, and other associated dangers.

I know that this Clinic entails moderate to vigorous exercise and I understand that it is my sole responsibility to participate in only those Clinic activities for which I have the prerequisite skills, qualifications, preparations, and training. I understand that it is solely my responsibility to monitor my own level of activity, to stop when I am tired and to make sure my workouts are serving my needs and respecting my personal health wellness limitations. In consideration of the Clinic and GW allowing me to participate in the Clinic, I hereby voluntarily assume all risks involved in such activities and voluntarily release, discharge, waive and relinquish any and all actions or causes of action, including but not limited to negligence, breach of contract or breach of any statutory or other duty of care for personal injury, property damage or wrongful death occurring to myself as a result of participating in such activity or activities incidental thereto wherever or however the same may occur and for whatever period said activities may continue against Healing with Basketball and GW, its trustees, officers, employees and agents. This release and waiver shall be binding on myself, my heirs, executors and administrators and assigns.

In checking this box, I hereby acknowledge and represent that I have read the foregoing terms and conditions, understand it, and sign it voluntarily; no oral representations, statements, or inducements, have been made; I am at least eighteen (18) years of age and fully competent; and I check this box for full, adequate, and complete consideration fully intending to be bound by the same.