Please fill out the entire form, sign and date, then FAX to: 205-877-8648
ATTN: Deputy Chief Bob Copus/Sgt. Ken Atkinson
Runner’s Name ____________________________ Runner’s T-shirt Size: _________
Agency___________________________________ Contact Phone # _____________
Email Address ________________________________
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY, AND
PARENTAL CONSENT AGREEMENT (“AGREEMENT”)
In consideration of participating in the Special Olympics Alabama, The Law Enforcement Torch Run Final Leg, I represent that I understand the nature of the running/and or driving events and that I and/or my minor child am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which traffic hazards are to be expected. I acknowledge that if I and/or my minor child believe event conditions are unsafe, I and/or my minor child will immediately discontinue participation in the Activity.
I fully understand that the running/and or driving events involve risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the “releasees” names below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I and/or my minor child incur as a result of my and/or my minor child’s participation in the Activity.
I hereby release, discharge, and covenant not to sue Special Olympics, Inc., Special Olympics Alabama, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise, including negligent rescue operations; and further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my and/or minor child’s behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releases from any loss, liability, damage, or cost which any may incur as the result of such claim.
I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, AND PARENTAL CONSENT AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in the full force and effect.
__________________________________________ __________________________________________
Printed Name of Participant Signature of Participant (only if age 18 or over)
Date: ______________________________________ __________________________________________
Signature of Parent/Legal Guardian
(If Participant under age 18)