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I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively,

"Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age),

knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITYand hereby waive any and all rights, claims or

causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge DRACUT OLD HOME DAY, located at PO Box 217, Dracut, Massachusetts 01826,

their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and

assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my

participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE

ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS

ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN,

SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS),

ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY

ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE

ACTIVITY, ORFROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED

RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

I FURTHER AGREEto indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any

kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's

fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or

entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or

treatment, I authorize Dracut Old Home Day to provide all emergency medical care deemed necessary, including but not

limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical

personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a

result of such treatment. I am aware and understand that I should carry my own health insurance.

I FURTHER ACKNOWLEDGEthat this Activity may involve a test of a person's physical and mental limits and may carry with

it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able

and properly trained, and I agree to abide by the decision of the Dracut Old Home Day official or agent, regarding my

approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY

UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Dracut

Old Home DayAND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF,

VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL

CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I

OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Dracut Old Home Day FOR PERSONAL INJURY OR

PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such

negligence on the part of Dracut Old Home Day, its agents, and employees.

I agree that this Release shall be governed for all purposes by Massachusetts law, without regard to any conflict of law

principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions,

neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of

neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION

IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement

between two parties of equal bargaining strength. Both Participant, _________________________ and Dracut Old Home Day

agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to

alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the

purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any

term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the

remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to

be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall

be deemed to be written, construed and enforced as so limited.

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM

FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY

UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS

IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.