LIABILITY WAIVER AND RELEASE FORM (MINOR CHILD) THIS IS A RELEASE OF

LEGAL RIGHTS — READ AND UNDERSTAND BEFORE SIGNING

I hereby certify that I am the adult parent or guardian of the minor child under the age of eighteen years to which this form pertains, and I consent to his/her participation in recreational activities, classes, or instruction organized by New England Cotillion LLC (DBA New Canaan Cotillion) I understand and acknowledge that I am fully aware of and assume the risks (including but not limited to the risk of serious bodily injury, property loss or damage) of (1) said minor child’s participation in recreational activities at the events. I recognize my responsibility to ensure that said minor child participates only in those activities for which he/she has the required skills, qualifications, training and physical conditioning.

I agree, personally and on behalf of the minor child named above, to assume all the risks and responsibilities (known or unknown) surrounding my minor child’s use of classes, activities and instruction organized and operated by New England Cotillion LLC (DBA New Canaan Cotillion) I agree on behalf of myself (and my spouse, all my children, personal representatives, heirs, executors, administrators, agents, and assigns) to forever release and discharge New England Cotillion LLC (DBA New Canaan Cotillion), New England Cotillion LLC (DBA New Canaan Cotillion) board members, their owners, employees, agents, representatives, affiliates, successors, and assigns from any and all claims or causes of action (known or unknown) arising out of the negligence of New England Cotillion LLC (DBA New Canaan Cotillion), whether active or passive, or that of any of its affiliates, employees, agents, representatives, successors, and assigns.

To the fullest extent allowed by law, I hold harmless and agree to indemnify New Canaan

Cotillion Inc., its officers, board members, directors, faculty, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property, which said minor child may suffer or for which said minor child may be liable to any other person, related to said minor child’s participation in recreational activities organized and/or operated by New England Cotillion LLC (DBA New Canaan Cotillion), resulting from any cause whatsoever, and regardless of fault.

I further expressly agree that the foregoing release, waiver, and indemnity agreement is

intended to be as broad and inclusive as permitted by the law of the state in which this

agreement is entered into, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further agree that no oral representations, statements or inducement apart from the foregoing written agreement has been made. I agree, for myself and my spouse, my children, successors, heirs, and assigns, that the above representations are contractually binding.

I am at least eighteen years of age and have carefully read and freely signed this Liability

Waiver and Release Form (Minor Child). I understand and agree that no oral or written

representations can or will alter the contents of this document. I agree that this agreement

shall be governed by the laws of the State of Connecticut (excluding its conflict of laws

principles). By entering my name below, I acknowledge and accept the terms outlined above.