I hereby grant Mni Ki Wakan, the absolute and irrevocable right and permission, in respect of the photographs and/or video taken of me alone
or with others, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever;
and to use my name in conjunction therewith if Mni Ki Wakan so chooses.

I hereby release and discharge Mni Ki Wakan from any and all claims and demands arising out of or in
connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy.

This authorization and release shall also inure to the benefit of the heirs, legal representatives,
licensees, and assigns of Mni Ki Wakan.

I am of full age (18) and have the right to contract in my own name. If I am not yet 18 years of age,
a parent or guardian has authorized my signature. I have read the foregoing and fully understand the
contents.

I/We the undersigned, being of lawful age, by affixing my/our signatures hereto, or checking the box hereto, do hereby agree to indemnify and to hold harmless the Mni Ki Wakan, its officers, employees, elected officials and agents, from and against any and all liability claims, actions, causes of action, demands, rights, damages, cost, loss of service, expenses, any health issues, and compensation for all negligence whether active or passive arising out of or in any way connected or related to the Mni Ki Wakan Summit to be held on August 16-18.

The 2023 Mni Ki Wakan Summit will require social distancing and participants to wear masks at all times (except when eating and drinking water). We ask participants to comply with Mni Ki Wakan health and safety protocols, and any applicable Center for Disease Control & Prevention (CDC) and state COVID-19 mandates and guidance that may be more stringent.

If you are feeling sick, have a cough, fever, or other symptoms, please do not attend. Mni Ki Wakan will have a health coordinator to provide masks and hand sanitizer. We will continue to monitor and update safety precautions for the Mni Ki Wakan Summit.