Pump a Heart, Save a Heart 5k
Join Kedma and JSU for this awesome event at 10:00 AM on September 17th to raise money for Save a Child's Heart! This organization is based in Israel and provides hundreds of children from developing countries with lifesaving cardiac surgery. For more information about this organization, please go to http://www.saveachildsheart.com/.

***PLEASE NOTE: You will not be allowed to participate in the run unless you pay so please make sure to click on the PayPal button listed at the bottom of the page.

Name *
Your answer
Year *
Email Address *
Your answer
T-shirt size
PLEASE READ AND SIGN BELOW: By registering for the Kedma's Pump a Heart, Save a Heart 5K, hereinafter called “The Activity,” I acknowledge that running or walking a road race is a potentially hazardous activity. I represent that I am medically able and properly trained to participate in The Activity. I agree to abide by any decision of an event official relative to my ability to safely complete the event, including suspending my participation. I acknowledge that The Activity may be conducted over public roads and facilities open to the public and their attendant hazards of traveling. I assume all risks associated with running and walking in The Activity including but not limited to falls, contact with other participants, the effects of weather including cold and high heat and humidity, traffic and the conditions of the road and sidewalks. I know, understand, and appreciate these and other risks are inherent in The Activity.In consideration of my voluntary participation in The Activity, I voluntarily agree to assume, on behalf of myself and my heirs, assigns and executors, all risks of loss, damage, and injury of any kind to me or my property that are associated with, related to or arise out of my participation in The Activity. In further consideration of being accepted to participate in The Activity, I hereby voluntarily release, indemnify and hold harmless the State of Maryland, the University System of Maryland and their respective officers, agents, employees, and students and Activity Sponsors (collectively “Indemnified Parties”) from and against any actions, causes of action, claims, demands, liabilities, costs, damages, and expenses of any kind that arise out of my participation, even those caused by the negligent acts or omissions of the Indemnified Parties.I hereby grant permission to the Indemnified Parties to photograph or videotape my participation in this public event and to publicly display or perform such Photographs without any additional permission from me or compensation to me to use for any legitimate purpose.I certify that I have had the opportunity to consult legal counsel of my choosing before signing this document, have read and understand the terms, contractual nature and legal significance of this document, and execute this Release and Indemnification Agreement voluntarily. *
Your answer
Date Waiver Signed *
Method of Payment *
Never submit passwords through Google Forms.
This form was created inside of University of Maryland. Report Abuse - Terms of Service - Additional Terms