RELEASE, INDEMNITY AND CONSENT AGREEMENT

In consideration of the acceptance by the St. Louis Service Bureau (“Service Bureau”)
of our son/daughter (“Participant”) as a participant in the Assembly/League Dance/Programs
(“Programs”), and of similar agreements by the parents of other participants, we agree to release,
defend and indemnify the Service Bureau, its employees and agents (including but not limited to
the persons serving as chaperones at each dance) directors and officers, against loss, damages or
expenses arising from any claim or suit brought against the Service Bureau or any of said persons:
(1) for any injury or damage which Participant may sustain before, during or after a dance sponsored
by the Service Bureau, and (2) for injury or damage sustained by anyone else alleged to arise from
the conduct of Participant occurring before, during or after a sponsored dance. We have read and
agree to comply with policies established by the Service Bureau and its Dance Committee for the
conduct of these programs and to use our best efforts to assure compliance by Participant.

We further consent to receive electronic communications at the below listed email
addresses, such as newsletters about the Service Bureau or other information regarding upcoming
programs and activities. We understand that if we do not want to receive such communications, we
may email or call the Service Bureau at 314-991-4803 or dance@stlservicebureau.org.

The Service Bureau may, in its sole discretion cancel any of the Programs and no refund
will be provided as a result of such cancellation. The Service Bureau, its participants or agents,
may, from time to time, take, obtain or reproduce photographs, digital images, videos, or other
recordings or likenesses (“Images”) of participants. We understand that such Images may be used
by the Service Bureau and made available to participants in the Programs who may further distribute
such Images. The Service Bureau is not responsible for the loss or theft of any cell phones that are
brought to the League/Assembly Dance.

The Agreement shall remain in effect while our child is a participant in any of the Dance
Programs maintained by the St. Louis Service Bureau during the current and future seasons and all
terms shall survive the termination of this Agreement.

Child’s participation in the Dances is contingent upon the signatures of the parents and the child on
this agreement.