This agreement releases {1in5 That’s My Story/Leslie Rubio} from all liability relating to injuries that may occur {during activity, on location, etc.}. By accepting the Terms and Conditions, I agree to hold {1in5 That’s My Story/Leslie Rubio} entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.

I also acknowledge the risks involved in providing the {written documentation of my personal story}. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.

By accepting the Terms and Conditions I forfeit all right to bring a suit against {1in5 That’s My Story/Leslie Rubio} for any reason. In return, I will receive {participation in the 1 in 5 project}. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.