Diabetes Connections presents Club 1921 will be held Wednesday November 4, 2026 at The Gladly, Phoenix.
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Photo release:
This release only applies to photos/images taken/captured at Diabetes Connections presents Club 1921 events.
I hereby grant Stacey Simms Media, LLC permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
I hereby irrevocably authorize Stacey Simms Media, LLC to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge Stacey Simms Media, LLC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE
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WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
1.
In consideration for receiving permission to participate in the Diabetes Connections presents Club 1921 event, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Stacey Simms Media LLC, their officers, agents, volunteers, or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any of the property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is
being conducted.
2.
I am fully aware of the unusual risks involved and hazards connected with this activity, I hereby elect to voluntarily
participate in said activity with full knowledge that said activity may be hazardous to me and my property.
I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE.
3.
I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any
loss, liability, damage, or costs, including court costs and attorney fees, that they may incur due to my
participation in said activity, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or
otherwise.
4.
It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the
members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am
deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO
SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold
Harmless Agreement shall be construed in accordance with the laws of the State of North Carolina