Participation Agreement

This Agreement (“Agreement”) is entered into by the undersigned participant (“Participant”) in connection with the SmileOnU Program (“Program”), provided by SmileOnU, a California public benefit corporation (“SmileOnU” or “Company”).

By signing this Agreement, Participant acknowledges and agrees to all terms below.

1. Authorization to Release Healthcare Information (HIPAA Compliance)

Participant authorizes SmileOnU to release all information contained in the Participant’s Hardship Case Application—including personal, medical, and photographic information (collectively, “Protected Health Information” or “PHI”)—to Dental Service Providers for the purpose of evaluating eligibility and arranging charitable dental services.

Acknowledgments and HIPAA Protections:

• This authorization is valid for two (2) years from the date of signing.

• Participant may revoke this authorization at any time in writing to SmileOnU; revocation will not affect information already used or disclosed.

• SmileOnU is not a covered entity, health plan, or healthcare provider under HIPAA and does not provide dental services.

• PHI disclosed under this authorization will be used only for the purposes of evaluating eligibility and arranging charitable dental services.

• SmileOnU will take reasonable measures to protect PHI and limit disclosure to the minimum necessary for the intended purpose.

• Participant releases SmileOnU from liability for the use or disclosure of information consistent with this authorization.

2. Publicity Waiver and Release

Participant irrevocably grants SmileOnU and its affiliates the right to use Participant’s name, likeness, image, voice, biographical information, and submitted materials for advertising, promotion, fundraising, or other purposes worldwide, in perpetuity.

Participant agrees:

• All intellectual property rights in submitted materials are assigned to SmileOnU.

• SmileOnU may edit, modify, or distribute materials without further consent or compensation.

• Participant waives all claims related to defamation, invasion of privacy, or use of materials, including materials containing PHI.

• Participant cannot revoke use of materials retroactively.

3. Release, Waiver of Liability, Assumption of Risk, and Indemnity

Participant acknowledges:

• Dental Service Providers are independent contractors, not agents or employees of SmileOnU.

• Participation involves risks including pain, infection, allergic reactions, injury, or death.

• Services provided are limited, voluntary, and may be terminated at any time.

Participant agrees:

1. Waiver and Release: Participant releases SmileOnU, its affiliates, volunteers, officers, directors, employees, and Dental Service Providers (collectively, “Releasees”) from any claims, demands, suits, or liabilities, whether caused by negligence, gross negligence, or otherwise, except for SmileOnU’s willful misconduct.

2. Indemnity: Participant will indemnify and hold harmless Releasees from any claims arising from participation, including claims by third parties.

3. Assumption of Risk: Participant voluntarily assumes all risks associated with dental services or Program participation.

4. No Guarantees: SmileOnU makes no representations or warranties about the skill, qualifications, or outcomes of any Dental Service Provider.

5. Emergency Care: SmileOnU does not provide emergency services; Participant is responsible for seeking necessary care independently.

6. Scope and Severability: This Release is intended to be as broad as permitted under California law, and if any provision is invalid, the remainder remains in effect.

5. Governing Law and Dispute Resolution

• This Agreement is governed by California law.

• Any legal action must be brought in California courts.

• Participant fully waives the right to a jury trial permitted by law.

6. Entire Agreement

This Agreement is the complete and exclusive agreement between Participant and SmileOnU regarding the Program. Any modifications must be in writing and signed by both parties.

7. Acknowledgment and Signature

By signing, Participant affirms:

• They have read, understood, and voluntarily agree to all terms.

• They understand this waives substantial legal rights, including the right to sue SmileOnU and related parties.

• They assume full responsibility for participation in the Program.

Participant Signature

If Participant is under 18, a parent or guardian must sign below, agreeing to all terms on behalf of the minor and representing authority to do so. Parent/guardian also authorizes emergency medical care if necessary.