INDEMNIFICATION: For Minor Participation

If less than eighteen (18) years of age, parent, guardian or custodian must sign the following
indemnification:

The undersigned parent, guardian, or custodian of the minor(s) named below, for himself/herself and the marital
community thereof, if such exists, and on behalf of said minor, hereby joins in the foregoing Waiver and Release
and hereby stipulates and agrees to save and hold harmless, indemnify, and forever defend SERR, its
directors, officers, agents, employees, members and volunteers from and against any claims, actions, demands,
expenses, liabilities (including reasonable attorney's fees), and NEGLIGENCE made or brought by said minor or
by anyone on behalf of said minor, as a result of said minor's participation in the activities or events
organized or sponsored by SERR including any acts or events occuring as a result of minor's use of, or presence
on the premises of SERR, which activities may include the use of SERR's property, equipment and/or animals
owned by SERR or loaned to SERR.

Date______________, 2010

Signature of Parent, Guardian or Legal Custodian of Minor(s)

_____________________________________________________________________

Print Name: ___________________________________________________________

Phone Number of Parent, Guardian or Legal Custodian of Minor(s)_______________________________

(1) Print Name(s) and Date of Birth of Minor ______________________________________________________

Signature of Minor __________________________________________________________________________

(2) Print Name(s) and Date of Birth of Minor ______________________________________________________

Signature of Minor __________________________________________________________________________

(3) Print Name(s) and Date of Birth of Minor ______________________________________________________

Signature of Minor __________________________________________________________________________

Date: ______________ SERR Witness: ______________________________________________