ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

I HEREBY RELEASE AND FOREVER DISCHARGE AND AGREE TO SAVE AND HOLD
HARMLESS THE PHILIPPINE COMMISSION ON WOMEN, THEIR OFFICIALS, BOARD
MEMBERS, EMPLOYEES, REPRESENTATIVES OR ASSIGNS AND THE ACTIVITY OR EVENT
SPONSORS, AND EVENT ORGANIZERS, AND GUINNESS WORLD RECORDS ANY AND ALL
INJURIES (INCLUDING PERSONAL INJURY, DISABILITY, DISMEMBERMENT, AND DEATH),
ILLNESS, LOSSES, DAMAGES, CLAIMS, LIABILITIES OR EXPENSES OF ANY KIND OR
NATURE ACCRUING TO ME, MY HEIRS OR MY PERSONAL REPRESENTATIVES THAT ARE
CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY MY ACTION, FAULT,
OMISSION, FAILURE TO ACT, OR BY MY BREACH OR ALLEGED BREACH OF THIS WAIVER
AND RELEASE, OR BY THE CONDITION OF THE PROPERTY, FACILITIES OR EQUIPMENT OF
ANY RELEASED PARTY OR THAT ARISE OUT OF OR IN CONNECTION WITH THE EVENT OR
MY PARTICIPATION IN THE SULONG JUANA WOMEN’S SYMBOL FORMATION.

THIS ACCIDENT WAIVER AND RELEASE OF LIABILITY SHALL BE CONSTRUED BROADLY TO

PROVIDE A RELEASE AND WAIVER TO THE MAXIMUM EXTENT PERMISSIBLE UNDER
APPLICABLE LAW.

- RELEASE AND AUTHORIZATION-

I HEREBY IRREVOCABLY AND PERPETUALLY PERMIT AND AUTHORIZE THE COCA-COLA

COMPANY (TCCC), THE COCA-COLA EXPORT CORPORATION-PHILIPPINES BRANCH
(TCCEC), ITS SUBSIDIARIES, AFFILIATES AND BOTTLERS, THEIR RESPECTIVE SUCCESSORS,
ASSIGNS AND THOSE ACTING UNDER THEIR PERMISSION TO DISPLAY IN ANY TYPE OF
ELECTRONIC OR DIGITAL MEDIA THROUGHOUT THE WORLD, USE, BROADCAST, PUBLISH
AND COPYRIGHT FOR ADVERTISING, PROMOTION, PUBLICITY, PACKAGING, PUBLIC
RELATIONS AND MEDIA PURPOSES AND FOR ANY OTHER LAWFUL PURPOSES
WHATSOEVER, THE NAME, IMAGE, PICTURE, VIDEO, STATEMENTS, RECORDINGS OR
INTERVIEWS, ENDORSEMENTS AND ANY OTHER INFORMATION ABOUT OR RELATED TO
SULONG JUANA HUMAN WOMEN'S SYMBOL FORMATION, AS WELL AS MY NAME AND
IMAGE, BIOGRAPHICAL INFORMATION, VOICE, STATEMENTS, RECORDINGS OR
INTERVIEWS AND ENDORSEMENTS MADE BY OR ATTRIBUTABLE TO ME, VERBATIM OR
OTHERWISE, PHOTOGRAPHIC PORTRAITS, DRAWINGS, VISUAL REPRESENTATIONS, VIDEO
TAPES, MOTION PICTURES OR OTHER USE OF MY LIKENESS IN WHOLE OR IN PART, AND
ANY REPRODUCTIONS THEREOF, IN ALL MEDIA NOW KNOWN OR HEREAFTER DEVELOPED
WORLDWIDE WITHOUT LIMITATION, IN CONNECTION WITH MY PARTICIPATION IN THE
EVENT.

I HEREBY WARRANT THAT IF A PHOTO/PICTURE OF THE EVENT INCLUDES AN IMAGE OF

ANY PERSON, I HAVE THE PERMISSION OF EACH PERSON PICTURED TO ALLOW HIS/HER
IMAGE TO BE USED BY US AS DESCRIBED ABOVE.

I HEREBY RELEASE AND DISCHARGE THE LICENSED PARTIES FROM ANY LIABILITY
WHATSOEVER, INCLUDING WITHOUT LIMITATION CLAIMS FOR INVASION OF PRIVACY,
DEFAMATION OF CHARACTER OR ANY ALTERATION, DISTORTION OR ILLUSIONARY
EFFECT, WHETHER INTENTIONAL OR OTHERWISE, IN CONNECTION WITH SAID USE. I DO
HEREBY WAIVE ANY RIGHT THAT I MAY HAVE TO INSPECT OR APPROVE THE FINISHED
PRODUCT OR ANY MATERIAL THAT MAY BE USED IN CONNECTION THEREWITH OR THE
USE TO WHICH IT MAY BE APPLIED.

I REPRESENT AND WARRANT THAT I AM AUTHORIZED TO ENTER INTO THIS RELEASE AND
THAT I HAVE OBTAINED OR DO NOT REQUIRE THE CONSENT OF ANY THIRD PARTY TO
ENTER INTO THIS RELEASE.

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ORGANIZATION NAME:

COORDINATOR:

DATE:

NAMES OF THE PARTICIPANTS

Name Signature

(NAME OF AGENCY HEAD)

SIGNATURE

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