Shibori Itajime – Member

Perennial: Assumption of Risk, Waiver and Release of Liability and Agreement

I wish to obtain certain training and instruction from Perennial (St. Louis), which may involve the use of various
tools and equipment, such as hammers, saws, pliers, box cutters, and the like (the “Training”). In consideration
of being able to participate in any way in the Training (as defined below):

1. I represent that I understand the nature of the activities involved in the Training. I am fully aware of the
risks and hazards connected with these activities, and voluntarily accept and assume full responsibility
for all risks of loss, property damage, death and personal injury that may be sustained by me as a result
of volunteering for or otherwise participating in the Training, whether caused by the negligence,
carelessness or strict liability of a “Released Party” (as defined below) or otherwise. The risks include,
without limitation, those caused by condition of participants and equipment, my skill using the
equipment and actions of other people. In addition to these potential risks, I understand that there are
also unpredictable dangers involved with athletic activities. Understanding the inherent risks and
dangers of participating in the Training, I represent that to the best of my knowledge that I have no
medical, physical, and/or emotional health condition which would hinder or prevent, whatsoever, my
participation in the Training and have not been advised to not participate in the Training by a qualified
medical person.
2. I, for myself, and on behalf of my family members, heirs, assigns, successors, personal representatives,
executors and next of kin, hereby fully and forever release, waive, discharge and covenant not to sue
Perennial, and its present and future affiliates, members, administrators, directors, shareholders, officers,
employees, volunteers, representatives and agents and all other parties and persons connected with
the Training in any way (each a “Released Party” and collectively, the “Released Parties”) from any and
all liability, loss, claims, demands, actions and causes of action whatsoever, present or future, whether
the same be known or unknown, anticipated, or unanticipated, arising out of or related to any loss,
damage or injury, that may be sustained by me, or to any property belonging to me, or resulting in
death, as a result of my participation in the Training, that are caused by the negligence, carelessness or
strict liability of any Released Party or otherwise.
3. I agree that if, despite the foregoing, I, or anyone on my behalf, makes a claim against any of the
Released Parties, I will indemnify, save, and hold harmless each of the Released Parties from any loss,
liability, damage, or cost which any Released Party may incur as a result of such claim.
4. I acknowledge receipt of all rules and regulations governing the Training and agree to comply with all
such rules and regulations.
5. I agree that this Assumption of Risk, Waiver and Release of Liability and Agreement is intended to be as
broad and inclusive as is permitted by the laws of the county in which the Training is conducted and the
State of Missouri and that if any portion hereof is held invalid, it is agreed that the balance shall continue
in full legal force and effect.

I certify that I have read the foregoing, fully understand that I have given up substantial rights by accepting the Terms and Conditions through Perennial’s website
and have accepted the Terms and Conditions freely of my own will and accord and intend my signature to be a complete and
unconditional release of all liability to the greatest extent allowed by law. I acknowledge and agree that there
is good and valuable consideration for each of the rights, obligations and agreements set forth herein.

Media Release

I hereby grant Perennial permission to use my likeness and my artwork in a
photograph, video, or other digital reproduction in any of its publications, including website entries,
without payment or any other consideration.

I hereby irrevocably authorize Perennial to edit, alter, copy, exhibit, publish or distribute these
photographs or videos for purposes of publicizing its programs or for any other lawful purpose. In
addition, I waive the right to inspect or approve the finished product wherein my likeness or artwork
appears. Additionally, I waive any right to royalties or other compensation arising or related to the
use of the photograph.

I herby hold harmless and release and forever discharge Perennial staff, official agents, and partners
from all claims, demands, and causes of action which I, my heirs, representatives, executors,
administrators, or any other persons acting on my behalf or on behalf of my estate have or may have
by reason of this authorization.

I have read this release before accepting Perennial’s Terms and Conditions and I fully understand the contents, meaning, and impact of this
release.

By accepting the Terms and Conditions, I certify that I am 18 years of age or older. I certify that if I am not 18 years of age, a legal guardian has accepted the Terms and Conditions on my behalf.