ACT GAS LLC
Assumption of Risk, Waiver of Liability, and Indemnity Agreement

THIS IS A RELEASE OF LEGAL RIGHTS.
PLEASE CAREFULLY READ AND UNDERSTAND THIS RELEASE BEFORE SIGNING.

The undersigned customer (“Customer,” “I,” “me,” “my”) of ACT Gas LLC, an Oregon limited liability company (the “Company”), is purchasing product(s) (the “Products”) from the Company. Customer hereby acknowledges and agrees to the terms and conditions of this Assumption of Risk, Waiver of Liability, and Indemnity Agreement (“Release” or “Agreement”) as follows:

1. I am a Customer of the Company of at least twenty-one (21) years of age and fully competent.
2. I am aware that certain Products may be subject to state and federal regulations, which may affect my intended use of the Products.
3. I understand that ACT Gas LLC is only a retailer of the Products, is not a manufacturer of the Products, and shall not be held liable by me for any regulatory requirements related to the manufacture of the Products.
4. I acknowledge that the Company has made no representations to me in connection with how the Products may be used, that I have made no representations to the Company in connection with my use of the Products, and that I am solely responsible for determining the suitability of the Products for their intended use.
5. I understand that Nitrous Oxide is not for human consumption.
   
6. I understand that inhaling Nitrous Oxide may be habit forming and/or physically harmful.
   
7. I understand that misusing Nitrous Oxide can cause accidents and/or death.
   
8. I understand that no person should use Nitrous Oxide for the purposes of causing intoxication, inebriation, or the dulling of the brain or nervous system.
   

ON BEHALF OF MYSELF, AND MY EMPLOYER, BUSINESS, HEIRS, SUCCESSORS, ASSIGNS,  GUARDIANS AND LEGAL REPRESENTATIVES (COLLECTIVELY, “MY RELATED PARTIES”), I  KNOWINGLY AND VOLUNTARILY AGREE TO ASSUME ALL OF THE KNOWN AND UNKNOWN  RISKS RELATED TO MY PURCHASE AND USE OF THE PRODUCTS, AND I ACCEPT SOLE  RESPONSIBILTY FOR ANY INJURY (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY,  DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY  KIND, THAT MYSELF, OR MY RELATED PARTIES, MAY EXPERIENCE OR INCUR IN CONNECTION  WITH MY PURCHASE AND USE OF THE PRODUCTS (“CLAIMS”). ON BEHALF OF MYSELF AND MY  RELATED PARTIES, I HEREBY AGREE TO RELEASE, COVENANT NOT TO SUE, DISCHARGE,  INDEMNIFY, DEFEND, AND HOLD HARMLESS, THE COMPANY (ACT GAS LLC), AND ITS OWNERS,  MEMBERS, MANAGERS, AGENTS, EMPLOYEES, CONTRACTORS, REPRESENTATIVES,  SUCCESSORS, AND ASSIGNS (THE “RELEASED PARTIES”) OF AND FROM THE CLAIMS,  INCLUDING ALL LIABILITIES, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND  (INCLUDING, WITHOUT LIMITATION, ATTORNEY FEES) ARISING OUT OF OR RELATING TO MY  PURCHASE AND USE OF THE PRODUCTS. I UNDERSTAND AND AGREE THAT THIS RELEASE INCLUDES ANY CLAIMS BASED ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE  RELEASED PARTIES. I HEREBY AGREE AND ACKNOWLEDGE THAT THE COMPANY (ACT GAS LLC)  WOULD NOT ALLOW ME TO PURCHASE THE PRODUCTS WITHOUT FIRST SIGNING THIS  RELEASE, AND THAT THIS RELEASE SHALL BE APPLIED AND ENFORCED TO THE FULLEST  EXTENT UNDER THE LAWS OF THE STATE OF OREGON OR ANY OTHER STATE WHICH MAY  HAVE JURISDICTION OVER A MATTER RESULTING FROM THIS AGREEMENT.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT: I have read the foregoing  Waiver of Liability, Assumption of Risk, and Indemnity Agreement, fully understand its contents, which I acknowledge  as true and correct, and sign it voluntarily as my own free act and deed; if any portion of the Agreement is held invalid,  it is agreed that the remaining provisions, notwithstanding, continue in full legal force and effect; no oral representations,  statements, or inducements, apart from the foregoing written Agreement, have been made; this is the entire Agreement  of the Customer and the Company and supersedes any prior written and/or oral agreements.

ACT Gas LLC Assumption of Risk, Waiver of Liability, and Indemnity Agreement