ASSISTANCE REQUEST FORM

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KAYDEN JAYCE REFERRAL PARTICIPANT AGREEMENT

This Agreement is entered into by and between KAYDEN JAYCE FOUNDATION, INC. hereinafter KAYDEN JAYCE and the PARTICIPANT.

This Agreement shall be effective upon the submission of the Application for Legal Services Request Form.

PARTICIPANT and KAYDEN JAYCE FOUNDATION, INC. are sometimes individually referred to as “Party” and collectively referred to as the “Parties”.

Whereas, PARTICIPANT agrees to hold harmless the KAYDEN JAYCE FOUNDATION, Inc. from any claims and/or litigation arising out of KAYDEN JAYCE FOUNDATION, INC.’s activities of providing education and referrals for legal services to justice rights matters under the scope of the vision of KAYDEN JAYCE.

NOW THEREFORE, in consideration of the mutual covenants and conditions contained herein, PARTICIPANT and KAYDEN JAYCE hereby agree as follows:

TERMS:

To the extent permitted by law,

PARTICIPANT agrees that KAYDEN JAYCE will assist the PARTICIPANT with securing legal services from one of the KAYDEN JAYCE Participating Attorneys.

PARTICIPANT may receive a credited allotment for those legal services.

PARTICIPANT will enter into a Legal Services Agreement with the Participating Attorney and is bound by the terms of that Agreement. KAYDEN JAYCE is not a party to that Legal Services Agreement.

1. Hold Harmless. PARTICIPANT shall fully defend, indemnify and hold harmless KAYDEN JAYCE FOUNDATION, INC. from any and all claims, demands, lawsuits, causes of action, loss, liability, injury and/or damage, of any kind whatsoever (including without limitation all claims for property damage, monetary loss, personal injury, equitable relief, and/or wrongful death), whether brought by an individual or other entity, or imposed by a court of law or by administrative action of any federal, state, or local governmental body or agency, arising out of, in any way whatsoever, any acts, negligence, omission, or willful misconduct on the part of KAYDEN JAYCE FOUNDATION, INC., its officers, owners, personnel, employees, agents, contractors, invitees, or volunteers. This indemnification applies to and includes, without limitation the payment of all penalties, judgments, fines, awards, attorneys’ fees, decrees, and related costs or expenses and any reimbursements to PARTICIPANT for all legal fees, expenses, and costs that are incurred by it.

2. Authority to enter the Agreement. Each party warrants that the individuals and/or entities that have entered into this Agreement have the actual legal power, right, and authority to make this Agreement and bind each respective party.

3. Amendment; Modification. No supplement, modification, or amendment of this Agreement shall be binding unless executed in writing and signed by both Parties.

4. Waiver. No wavier of any default shall constitute a waiver of any other default or breach, whether of the same or other covenant or condition. No waiver, benefit, privilege, or service voluntarily given or performed by a Party shall give the other Party any contractual right by custom, estoppel, or otherwise.

5. Attorneys’ Fees and Costs. If any legal action or other proceeding is brought in connection with this Agreement, the successful or prevailing Party, if any, shall be entitled to recover reasonable attorneys’ fees and other related costs, in addition to any other relief to which that Party is entitled. In the event that it is the subject of dispute, the court or tier of fact who presides over such legal action or proceeding is empowered to determine which Party, if any, is the prevailing party in accordance with this provision.

6. Entire Agreement. This Agreement contains the entire agreement between the Parties related to the matters specified herein, and supersedes any prior oral or written statements or agreements between the Parties related to such matters.

7. Enforceability, Severability, and Reformation. If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited. The intent of the Parties is to provide as broad an indemnification as possible under Georgia law. In the event that any aspect of this Agreement is deemed unenforceable, the court is empowered to modify this Agreement to give the broadest possible interpretation permitted under Georgia law.

8. Applicable law. The Agreement shall be governed exclusively by the laws of Georgia, without regard to conflict of law provisions.

9. Exclusive Venue and Jurisdiction. Any lawsuit or legal proceeding arising out of or relating to this Agreement in any way whatsoever shall be exclusively brought and litigated in the federal and state courts of Georgia. Each Party expressly consents and submits to this exclusive jurisdiction and exclusive venue. Each Party expressly waives the right to challenge this jurisdiction and/or venue as improper or inconvenient. Each Party consents to the dismissal of any lawsuit that they bring in any other jurisdiction or venue.

10. Signatures. This Agreement shall be signed on behalf of KAYDEN JAYCE FOUNDATION, INC. and by PARTICIPANT and effective as of the date below. Electronic signature shall be allowed.

PARTICIPANT HEREBY ACKNOWLEDGES HAVING READ THE ENTIRE DOCUMENT AND AGREEING TO THE TERMS OF THIS AGREEMENT. THE PARTICIPANT UNDERSTANDS ALL THE TERMS OF THE AGREEMENT, IS SIGNING THE DOCUMENT FREELY, VOLUNTARILY AND IS SUBJECT TO ANY FORM OF DURESS, THREAT OF DURESS, INDUCEMENT, PROMISE OR ANY OTHER CIRCUMSTANCES IN CONNECTION WITH SIGNING THIS DOCUMENT.

On behalf of the KAYDEN JAYCE FOUNDATION, INC.

I hereby agree that all the above is true to the best of my ability. By submitting this form I am agreeing to the terms and conditions. Submission of this agreement serves as my signiture.