AntiGravity MX, LLC

MINOR - CERTIFICATION, CONSENT AND AUTHORIZATION FOR MINOR(S):

I, the below signed parent and natural or legal guardian of the below named minor(s), acknowledge that I executed and understood the WAIVER, RELEASE, INDEMNIFICATION AND COVENANT NOT TO SUE AGREEMENT for and on behalf of both Releasors and the minor(s) named below. This representation by me is given to induce Releasees to permit the Releasors to use the Property for recreation including the operation of vehicles and other activities which are inherently dangerous, and I agree Releasees are absolutely and unconditionally entitled to rely on my agreements, covenants, and assertions provided herein. I bind myself, the minor(s), and our executors, administrators, heirs, estate, successors, and assigns to the said Agreement. I have the legal capacity and authority to act for and on behalf of the minor(s) named below. I will indemnify, defend and hold harmless the Releasees for any expenses incurred by them, and for any claims made or liabilities assessed against them, as a result of any insufficiency of my legal authority to act for the minor(s) in the execution of the Agreement or in the execution of this CERTIFICATION, CONSENT AND AUTHORIZATION. I agree I may request a copy of this document.

If Releasors operate vehicles on the Property we will wear helmets and other appropriate protective gear at all times while doing so. I certify any vehicles Releasors may operate on the Property, and all associated equipment, is safe and in good condition. I acknowledge that any operation of vehicles on the Property poses serious risk of injury, disability, or death to both the operator and others in and around the Property, and such risk may reasonably be expected to be lower for those persons who have greater skill and experience in the operation of such vehicles. Releasees offer a separate area of the Property in which Releasors may practice safe riding skills in a less dangerous environment. I agree Releasees make no claim that such practice will prevent injury, disability, or death, but make such offer in the reasonable belief that it may reduce the likelihood of injury or death.

I authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility (“Medical Provider”) to treat the minor(s) named below for attempting to treat or relieve any injuries received by said minor(s). I authorize any such Medical Provider to perform all procedures deemed medically advisable by the Medical Provider in attempting to treat or relieve any such injuries and any related conditions of said minor(s) that may be encountered during the course of attempting to treat or relieve such injuries. I consent to the administration of anesthesia during such treatment. I realize there is a possibility of complications and unforeseen consequences in any medical treatment, and I release Releasees, covenant not to sue Releasees, and agree to indemnify, defend and hold harmless Releasees and assume any such risk related to medical treatment, for and on behalf of said minor(s) and myself. I acknowledge no warranty is being made as to the results of any medical treatment.

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Print Name of Parent/Guardian

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Signature of Parent/Guardian

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Print Minor’s Name and date of birth