5k Waiver

FUNDRAISER FOR THE BENEFIT OF MENtors ADULT PARTICIPANT AND PARENT/GUARDIAN WAIVER, ASSUMPTION OF RISK, RELEASE AND CONSENT FOR CHILD/CHILDREN PARTICIPANT UNDER THE AGE OF 18.
Name *
Email *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Shirt Size
S
M
L
XL
XXL
XXXL
Youth
Women
Men
I, for myself and my child/children and in consideration of my participation and my child’s/children’s participation in or attendance at the Fundraiser for the Benefit of MENtors Event (the “Event”) do hereby acknowledge and agree as follows: Acknowledgment and Assumption of Inherent and Other Risks: By checking the box on this online Waiver indicating my electronic signature I, for myself and any and all of my minor child/children participating in or attending the Event, acknowledge and agree that MENtors is not providing me or my child/children with insurance or legal advice. The activities associated with the Event carry inherent and other risks that can cause participants harm. I have had the opportunity to obtain information about the activities and the risks they carry. Neither I nor my child/children have any mental or physical condition that will place me or my child/children or others at risk on account of participation in the Event and my child/children and I are properly trained and medically able to participate in the Event. I am signing for myself and as the parent or guardian of any and all of my minor child/children participating in or attending the Event. I give my permission for my child/children to participate and I accept and assume full responsibility for any risk of injury, death or loss I or my child/children may suffer on account of my participation or the participation or attendance of my child/children in the Event. Release of Claims & Indemnity: By checking the box on the online registration form indicating my electronic signature, for myself and on behalf of my minor child/children, I AGREE TO RELEASE, AND NOT TO SUE, MENtors., An Ohio NOT-FOR-PROFIT 501c3 charitable organization, ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, LEADERS, AND ADVISORS (COLLECTIVELY “MENtors”), THE MUNICIPALITY IN WHICH THE EVENT WILL TAKE PLACE, AND ORGANIZERS OR SPONSORS OF THE EVENT WITH RESPECT TO ANY AND ALL CLAIMS FOR ANY INJURY, DAMAGE, DEATH, OR OTHER LOSS IN ANY WAY CONNECTED WITH MYSELF OR MY CHILD’S/CHILDREN’S PARTICIPATION IN OR ATTENDANCE AT THE EVENT. I UNDERSTAND THAT I AM AGREEING TO WAIVE ALL CLAIMS I OR MY CHILD/CHILDREN MAY HAVE AGAINST MENtors (INCLUDING NEGLIGENCE), AND AGREE THAT NEITHER I NOR MY CHILD/CHILDREN, NOR ANYONE PURPORTING TO ACT ON BEHALF OF ME OR MY CHILD/CHILDREN MAY MAKE ANY CLAIMS AGAINST MENtors, THE MUNICIPALITY IN WHICH THE EVENT WILL TAKE PLACE AND SPONSORS OR ORGANIZERS OF THE EVENT AS A RESULT OF ANY INJURY, DAMAGE, DEATH OR OTHER LOSS SUFFERED BY ME OR MY CHILD/CHILDREN. On behalf of myself and my participating child/children, I further agree to defend and indemnify (meaning protect and compensate) MENtors with respect to any and all claims: 1) brought by or on behalf of me or my child/children, or by or on behalf of any other person (including family members) for any injury, damage, death, or other loss I or my child/children may suffer in connection with my own or my child’s/children’s participation in or attendance at the Event; or 2) brought by any person for any injury, damage, death, or other loss to the extent caused by myself or my child/children. Images/Consent. I grant to MENtors or its designees, the irrevocable right and permission to photograph, film, record, and otherwise capture my own and/or my participating child’s/children’s name, image, voice, statement, photograph, or likeness (collectively “recordings”) and use or sublicense them in any media throughout the world, in perpetuity, including for reproduction, display, or otherwise (e.g., on websites, on social media, in publications, or for informational, educational, promotional, or other purposes), without compensation to me or my child/children. I agree that MENtors owns its own respective recordings and all copyrights in them. I waive any inspection or approval rights. Other Provisions. I (for myself and on behalf of my participating child/children) agree:• I authorize MENtors, the Event organizer(s), volunteers, medical personnel, or others to obtain or provide medical care for myself, my child/children, to transport my child/children and/or I to a medical facility, and to provide treatment they consider advisable for myself and/or for my child’s/children’s health. I agree to pay all associated costs. I authorize the release of my own and/or my child’s/children’s medical records and personal information by or to the Event organizer(s) and MENtors, if necessary or useful for treatment, referral, billing, or insurance purposes.• I am signing this Waiver, Assumption of the Risk, Release and Consent for myself and as a parent or guardian, and if my parental status or authorization to sign on my behalf or on behalf or on my child’s/children’s behalf is challenged or found invalid, I will not sue, and will indemnify and defend, MENtors to the fullest extent allowed by law and this agreement, just as if I were the participant’s parent or guardian or authorized signatory for myself. I will also indemnify and defend MENtors against any claims, by any person or agency that takes the position that my signature was not effective. This document is intended to be interpreted and enforced to the greatest extent allowed by law. If any portion of this document is deemed unlawful or unenforceable, it shall not affect the enforceability of the remaining provisions, which shall continue in full force and effect. Authority. I represent and warrant that I am 18 years of age or older and that I am the Parent and/or Legal Guardian of any and all of my child/children participating in or attending the Event, and that I have authority to sign this Waiver on behalf of myself and on behalf of such child/children. I have carefully read and fully understand the terms of this Waiver, and voluntarily sign this document and acknowledge that it shall be effective and legally binding on me, my participating child or children, and my own and my child’s or children’s family members, heirs, executors, representatives, insurers, assigns, and estate. I understand that I am giving up substantial rights, including the right to sue the MENtors. and all other parties identified under this Waiver, Assumption of Risk, Indemnity and Consent. I hereby provide a complete and unconditional release of all liability to the greatest extent allowed by law.
Clear selection
I understand that my Registration is not final until I Checkout. *
Captionless Image
Submit
Never submit passwords through Google Forms.
This form was created inside of MENtors. Report Abuse