RELEASE OF LIABILITY AND ASSUMPTION OF RISK

have informed myself of the policies, procedures and methods employed by Speech Start, LLC (“Speech Start”) in providing speech therapy, occupational therapy and group therapy (the “Services”), and consent to the use thereof in providing the Services to my child,

I acknowledge the potential risks of my child engaging in the Services, which include, by way of example, physical injury due to activity-related accidents. In addition, I acknowledge that there may be other risks inherent in these activities of which I may not be presently aware. After considering the inherent risks, I feel that the possible benefits are greater than the possible risks, and I am knowingly and voluntarily permitting my child to participate in the Services. I agree to accept and assume any and all risks of injury arising from my child’s participation in the Services, whether caused by negligence or otherwise. I hereby, as parent or legal guardian, intending to be legally bound, for myself, my child, and our respective heirs, executors or administrators, successors and, assignees, hereby waive and release any and all claims, now known or hereafter known, against Speech Start, and its officers, manager(s), members, employees, independent contractors, agents, affiliates, successors, and assigns (collectively, “Releasees”), arising out of or attributable to my child’s participation in the Services, whether arising out of the ordinary negligence of Speech Start or any Releasees or otherwise. I covenant not to make or bring any such claim against Speech Start or any other Releasee, and forever release and discharge Speech Start and all other Releasees from liability under such claims. I confirm that I have disclosed all medical conditions of my child that may be affected in any way by my child’s participation in the Services. I acknowledge that I am responsible for updating Speech Start if the medical condition of my child changes. I acknowledge that I have been given sufficient time to ask questions, if any, concerning the nature and scope of this release. I have read the entire release and agree to it. This release constitutes the sole and entire agreement of Speech Start and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this release or invalidate or render unenforceable such term or provision in any other jurisdiction. This release is binding on and shall inure to the benefit of Speech Start and me and our respective heirs, successors, and assigns. All matters arising out of or relating to this release shall be governed by and construed in accordance with the internal laws of the State of New Jersey without giving effect to any choice or conflict of law provision or rule (whether of the State of New Jersey or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Monmouth County, New Jersey and I hereby consent to the exclusive jurisdiction of such courts. I am the parent or legal guardian of the minor named above. I have the legal right to consent and, by signing below, I hereby consent and agree to the terms and conditions of this Release of Liability and Assumption of Risk.