EVENT PARTICIPATION WAIVER AND RELEASE OF LIABILITY
City: ___________________________________________________________ State: ________ Zipcode: ____________________
Email Address: ______________________________________________________ Phone Number: ______________________________
Emergency Contact: ________________________________________________ Phone Number: ______________________________
By signing, you agree to the following:
WAIVER AND RELEASE OF LIABILITY
I (we), including any family member, and/or minor children accompanying me, am about to voluntarily participate in a series of running and exercise activities organized, operated, funded, and/or supplied by the Dick Pond Racing Team (Team Running Activities) and its respective leaders, organizers, officers, directors, employees, agents, attorneys, and other representatives, including without limitation, Dick Pond Athletics, Inc., and any and all of Dick Pond Athletics, Inc.'s parent entities, subsidiaries, affiliated entities, shareholders, directors, officers, employees, agents, and other representatives (collectively referred to as the Released Parties).
I (we) understand that the Team Running Activities will involve rigorous running and related physical exercise and activities, and that I (we) am participating in the Team Running Activities to benefit from the Team's assistance in improving my health and furthering my running and exercise goals. Notwithstanding any other provision in this Waiver and Release, I (we) understand that my participation in the Team Running Activities is purely and completely voluntary, and that at no time will I (we) be required to act, or refrain from acting, by the Team or by any of its organizers or representatives.
I (we) understand that the Team Running Activities will be conducted at various times and locations as scheduled from time to time by the Team and its organizers or representatives, and I (we) understand that any and all running or exercise activities in which I (we) participate, whether physically with the Team or any of its members, or on my own or with others at the suggestion, recommendation, or advice of the Team, are included within the Team Running Activities subject to this Waiver and Release.
By accepting this Waiver and Release, I (we) acknowledge that the Released Parties shall not be, and shall never be, legally responsible for my personal health, or any pain, discomfort, or injury of any kind, including without limitation any disability or death, that I(we) may suffer which arise from or relate to my (our) participation in Team Running Activities, or any damage or loss to any of my property. I (we) hereby release, hold harmless, and forever discharge the Released Parties from any and all liability or damages to me (us), any member of my family, my heirs or assigns, or my property arising from or related to the Team Running Activities described herein.
I (we) understand that at various events, I (we) may be photographed. I (we) agree to allow my photo, video, or film likeness to be used for the Team's social media and marketing purposes.
Participant Signature: ________________________________________________________ Date: _____________________________
Parent (Guardian) Signature: __________________________________________________ Date: _____________________________
(required if participant is under the age of 18)
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Amount Received: ______________ Online / Cash / Check Received By: __________________________ Date: ______________________________