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Advance Release Ultra Hazardous Activity

[Name] of [Address], hereinafter referred to as "Contestant", and [Name] of [Address], hereinafter referred to as "Show Organizer", agree:

Show Organizer offers the following activity:

The parties agree that:

(a) this activity is by its nature hazardous and despite the exercise of all due care, personal injuries or death may occur in this activity;

Initial here ______ as to paragraph (a) check [ ]

(b) that Show Organizer has given Contestant a full and adequate opportunity to ask questions and obtain a full and complete explanation of the risks of the activity;

Initial here ______ as to paragraph (a) check [ ]

(c) that the Contestant, on behalf of Contestant and the heirs, successors and assigns, herewith releases Show Organizer from any and all liability for personal injuries, consortium or other claims arising out of participating in the activity, except for any action resulting from willful and malicious actions by Show Organizer.

The failure of a party to object to, or to take affirmative action with respect to, any conduct of the other which is in violation of the terms of this Advance Release shall not be construed as a waiver of the violation or breach or of any future violation, breach, or wrongful conduct until (--) days since the wrongful act or omission to act has passed.

In connection with this Advance Release and the transactions contemplated hereby, each party to this Advance Release will execute and deliver any additional documents and perform any additional acts that may be necessary or appropriate to effectuate and perform its obligations under this Advance Release and the transactions contemplated hereby.

Initial here ______ as to paragraph (c)

Dated:

Signature

Contestant

Signature

Contestant

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss: [date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)