WAIVER AND RELEASE OF LIABILITY
Rack Attack Fun Run & Workout 2019
Phone: ______________________________ Email: _______________________________
Participant’s Address: ______________________________________________________________
Date of Birth (if under 18 yrs) : _______________________________________________________
PARENT / GUARDIAN WAIVER FOR MINORS
In the event that the participant is under the age of consent (18 years of age), then this release must be
signed by a parent or guardian, as follows:
I hereby certify that I am the parent or guardian of ____________________________, named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Parent / Guardian Name: __________________________________________________________
Relationship to Minor: ____________________________________________________________
In the event of an emergency, please contact the following person(s) in the order presented:
Emergency Contact / Contact Relationship / Contact Telephone
In consideration of the risk of injury while participating in The Rack Attack Fun Run & Workout (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter in to this waiver and release of liability and herby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do herby release and forever discharge Valoree and John Longo, located at 21 Ten Rod Rd, Voluntown, CT 06384, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct results of my participation in aforementioned Activity, including traveling to and from an event related to this Activity.
I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK.
I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELLING TO AND FROM AS WELL AS PARTICIPATING IN THE ACTIVITY, WHICH MAY INCLUDE, BUT NOT LIMITED TO MYSICAL OR PSYCHOLIGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH.
I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.
Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of these events for any legitimate purpose, including commercial advertising, without monetary payment to me. (This information is protected by the Privacy Act).
In the event that any damage to equipment or facilities occurs as a result of me or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.
This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant,
In the event that I should require medical care or treatment, I agree to be financially responsible for any
costs incurred as a result of such treatment.
I acknowledge that I have carefully read this “waiver and release” and fully understand that it is a release of liability. I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will.
Participant’s Name: _______________________________________________________________