7 LEAVES HOLDING, INC. DBA 7 LEAVES CAFÉ

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SN I do hereby release and forever discharge the Released Parties from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with my or, if applicable, my minor child's participation in the above named activity or with the decision by any representative or agent of the Released Parties, or any of them, to exercise the power to consent to medical or dental treatment as such power may be granted by me for my minor child. SN I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that City of Santa Ana has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19, and that City of Santa Ana cannot guarantee that I will not become infected with the Coronavirus/Covid-19. SN I understand that this release discharges City of Santa Ana from any liability or claim that I, my heirs, or any personal representatives may have against the City of Santa Ana with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any activities/events at City of Santa Ana. I HAVE READ, UNDERSTAND AND VOLUNTARILY AGREE TO THIS RELEASE OF LIABILITY AND WAIVER. I FURTHER AGREE THAT NO ORAL STATEMENTS, REPRESENTATIONS OR INDUCEMENTS, APART FROM THIS RELEASE AND WAIVER, HAVE BEEN MADE TO ME TO OBTAIN MY CONSENT. Sandra Ninh (please print) Participant Signature 01/31/2024 Date IF PARTICIPANT IS UNDER 18, THE SIGNATURE OF AGREEMENT BY A PARENT OR LEGAL GUARDIAN IS ALSO REQUIRED, AND SUCH PERSON FURTHER AGREES, PURSUANT TO THIS TWO -PAGE RELEASE OF LIABILITY AND WAIVER, TO RELEASE AND INDEMNIFY THE CITY FOR ANY INJURY OR DEATH TO, OR ANY CLAIM BY OR ON BEHALF OF, SUCH MINOR CHILD. Parent/Guardian Name (please print) Parent/Guardian Signature Date A� c,,^., � {j Rzhnre Form 2023 2 1