Laps for Love Online Registration Form
September 9th, 2018 (12:00-3:00)
Participant's First Name: *
Your answer
Participant's Last Name: *
Your answer
Address: *
Your answer
Cell Number: *
Your answer
Email Address: *
Your answer
Age: *
Your answer
Gender: *
Size(t-shirt): (T-shirts will be given to those who raise more than 50 dollars in pledges)
Released Parties: include the organizers, officials, volunteers, and sponsors of Laps for Love Charity Event; host facility whose property and/or personnel are used; and any or all parent, subsidiary or affiliate companies, licensees, officers, directors, partners, board members, supervisors, insurers, agents, equipment suppliers, and representatives of any of the foregoing. Releasing Parties include: the participant as well as participant’s spouse, children, parents, guardians, heirs, next of kin, and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on participant’s behalf. ASSUMPTION OF INHERENT RISKS: I am voluntarily entering or agreeing to be a volunteer at the event I am registering for herein (the “Event”). I agree not to enter into or volunteer at the Event unless I am medically able and properly trained. I agree to abide by any decision of an Event official relative to my ability to safely complete the Event. I recognize that participation in the Event is a potentially hazardous activity and I willingly assume all risks associated with such participation, including, but not limited to, falls; contact with other participants, spectators or others, or vehicular or other traffic; the effects of the weather, including heat and/or humidity, wind, cold, temperature, and wet or icy surfaces; falling tree branches or other overhead objects. I also understand that it is my responsibility to consult with my personal physician prior to participating in the Event to ensure that such participation will not pose any unusual risks to my health and well-being. Having read this Agreement and knowing these facts, and in consideration of your acceptance of my application for the Event, I, for myself and anyone entitled to act on my behalf, waive and release the Released Parties from present and future claims and liabilities of any kind, known or unknown, arising out of my participation in the Event, including, but not limited to, claims for damage for personal injury and/or property damage, any claim of right in respect of the Images (as defined below), including, but not limited to, claims of false endorsement or rights of publicity or privacy, even though such claim or liability may arise out of negligence or fault on the part of any of the Releasing Parties. AUTHORIZATION: I grant medical personnel at the Event permission to administer or arrange for any medical assistance that they deem necessary or appropriate as a results of my participation in the Event, including without limitation, arranging transportation to a hospital or other medical facility. I also grant them access to my medical records and physicians, as well as other information, relating to medical care that may be administered to me at any such medical facility as a result of my participation in the Event. TERMS AND CONDITIONS: I hereby understand, acknowledge and agree that once I have entered a race, my entry fees are non-exchangeable, non-transferable, and non-refundable, under any and all circumstances, including, but not limited to, cancellation of the event or of your participation, or change in the date, nature, or format of the event. I hereby understand, acknowledge and agree that an event may be cancelled or changed due to severe weather or other factors that threaten the safety of participants, staff, or volunteers. I further understand, acknowledge and agree that cancellation or change of the date, nature or format of an event may be mandated by governmental officials or otherwise be at the discretion oforganizers, officials, volunteers and sponsors of Laps for Love Charity Event; I hereby understand, acknowledge and agree that the Laps for Love Charity Event reserves the right to reject any entry and to disqualify and bar any individual from any event for any reason. PUBLICITY RELEASE: I hereby grant to Laps for Love, the irrevocable and assignable right to depict in perpetuity, worldwide, and in any and all media now or hereafter known, my likeness, image, name, words, voice and/or biographical information of me participating in the event (collectively “Images”) in photographic works, motion pictures, video recording and/or other works, and I agree that such Images may be used by Laps for Love, for any purpose without compensation. GUARDIAN’S PERMISSION AND RELEASE FOR MINOR: If I am or will be applying for my child’s participation in, or be a volunteer at, the Event, I represent and warrant that I am the parent or legal guardian of the child and, as such, consent to my child’s participation in the Event and I agree that the terms of this Agreement apply equally to my child and me and any claims I or my child may have in connection with the Event. I also waive any derivative claims that relate to or arise out of my child’s participation in the Event. ACKNOWLEDGEMENT OF UNDERSTANDING: I have read this Agreement and fully understand its terms. I understand that I am giving up substantial rights, including my right to sue. I further acknowledge that I am freely and voluntarily agreeing to the Agreement and participating in the Event, and intend my acceptance to be a complete and unconditional release of all liability due to ORDINARY NEGLIGENCE of Laps for Love. (and other Released Parties) or the INHERENT RISKS of the activity, to the greatest extent allowed by law in the State in which the Event is held. *
Signature:
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Emergency Contact Information: (if under 18)
Name:
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Cell Number:
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Relation:
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