First Name: Last Name:

Spouse Name:

Email:

Address:

City: State: Zip:

Emergency Contact Name: Emergency Phone Number:

Emergency Contact Relationship:

Children (Under the age of 18):

Name: Age:

Name: Age:

Name: Age:

Name: Age:

The undersigned guest agrees (on behalf of the guest and all children named above) that by signing below and/or making use of or accepting the use of the Houstonian Campus (which includes, without limitation, (i) all Houstonian Club facilities, (ii) Spa facilities, (iii) Hotel/Resort facilities, (iv) the Meadow, grounds and outdoor track and (v) parking areas, and any Club facility, apparatus, appliance, privilege or service whatsoever owned, leased or operated by Houstonian Campus, LLC (“owner”), or by engaging in any contest, game, function, exercise, competition or other activity operated, organized, arranged or sponsored by the owner, either on or off the Houstonian campus (collectively, the “activities and use”), (i) does so at his or her or their own risk and expressly assumes all dangers and risks associated with the activities and use, including but not limited to, the risk of injury or death and damage to or destruction of property and (ii) on behalf of himself or herself, the children named above and all heirs, administrators, legal representatives, family members, successors and assigns of the guest and the children named above, does hereby fully and forever discharge, release, agree to defend, indemnify and hold harmless (a) the owner, its members, managers, partners, operators, officers, directors, investors, employees, volunteers, coaches, contractors, vendors, affiliates, agents and subsidiaries; and (b) all of their respective employees, officers, directors, shareholders, owners, members, managers, partners, agents, attorneys, insurance providers, representatives, consultants and contractors, and for each of the parties in (a) and (b) above, their respective heirs, successors and assigns (collectively, the “released parties”), from any and all liabilities, injuries, rights of action, causes of action, losses, damages, claims, demands, loss of compensation, costs and expenses (including attorneys’ fees, court costs, costs of investigation and expert fees) whether related to property damage, personal injury, death of persons or otherwise (collectively, “claims”), whether the same be known, anticipated or unanticipated, that may occur as a direct or indirect result or arising out of, regarding or relating to the activities and use, whether due to negligence or otherwise, of the released parties.

The provisions of any state, federal or local law providing that a release shall not extend to claims, demands, injuries or damages which are unknown or unsuspected to exist at that time, to the person executing such release, are hereby expressly waived.

This release is given in consideration of Owner providing access to The Houstonian Campus. The undersigned acknowledges that all use of The Houstonian Campus shall be pursuant to rules and regulations adopted by Owner in its sole discretion.

I represent by clicking below that I am the parent or legal guardian of the above named children, and I have full legal capacity and authority under the law to act for and on behalf of such children. I agree to defend, indemnify, and hold harmless the Released Parties for any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the named children in the execution of this release.

by clicking the "Agree to Terms and Agreement" below I HEREBY AFFIRM THAT I HAVE READ, AGREED TO AND FULLY UNDERSTAND THIS AGREEMENT AND HAVE VOLUNTARILY ENTERED INTO THIS AGREEMENT OF MY OWN FREE WILL.