COVENANT NOT TO SUE & IMAGE RELEASE Event Location: Bennick Compound 5372 Roy McGalliard Ave Morganton, NC 28655
Sign_____________________________________________________
In consideration of being allowed to participate in any way in the above referenced Ohana Mud Run competition(s), race(s), related events (the “Event”) and/or activities, I, the undersigned, acknowledge, covenant and agree that:
(ii) near-drowning; (iii) sprains; (iv) strains; (v) fractures; (vi) heat and cold injuries; (vii) over-use syndrome; (viii) injuries involving vehicles; (ix) animal bites and/or stings; (x) contact with poisonous plants; (xi) accidents involving, but not limited to paddling, climbing, biking, hiking, skiing, snow shoeing, travel by boat, truck, car,or other convenience;(xii) heart attack and (xiii) the potential for permanent paralysis and/or death. While particular rules, equipment, and personal discipline may reduce this risk, the risk of death or serious injury does exist;
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Participant Name Participant 1 (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
Participant Name Participant 2 (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
Participant Name Participant 3 (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
Participant Name Participant 4 (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
Participant Name Participant 5 (PRINT): __________________________________________________
Signature _______________________________________ Date ____________________
EMERGENCY CONTACT (required) Name _______________________________________ Phone ____________________
MINORS: IF UNDER 18 – SIGNATURE OF PARENT OR GUARDIAN (required)
The undersigned, _______________________________________, hereby certifies, warrants and represents that I am the legal parent or guardian of
Print: _________________________________________
Print: _________________________________________
Print: _________________________________________
Print: __________________________________________
Print: __________________________________________
the signer of the above Release (the “Participant”), and that after fully informing myself regarding the nature and
risks of the Event, I give my permission for Participant to participate in the same and by my signature below I fully ratify, accept and agree to all of the terms of the above Release both for myself individually and as legal parent or guardian of the Participant.
Signature _______________________________________ Relationship to minor ______________________________
WAIVER: I, the undersigned participant (and my parent or guardian if I am younger than 18 years of age), intending to be legally bound, do hereby forever release and waive any and all rights, claims, and actions for damages that we, our heirs, executors, administrators, and assigns may have, or that may hereafter accrue against any and all persons, organizations, and other entities associated with the event, including, but not limited to Race Entry, Alive Cubed, sponsors, affiliates, volunteers, Ohana Mud Run, and individual Ohana Mud Run organizers, arising out of or in connection with my involvement before, during, or after the event.
I verify that I am physically fit and sufficiently trained to participate in this event and I assume the risks involved in this activity. I further attest that I will be mindful of traffic along the race course, and hold said sponsors and organizers blameless in any harm that may happen.
I consent to the collection and use of my Personal Information as contained in the Privacy Policy. I also give my permission for the free use of my name and/or pictures in telecasts, broadcasts, newspapers, posters, advertising, etc.
I also acknowledge understanding that the charge to my card will show up as Race Entry. I acknowledge that the online processing fees and charitable donations are non-refundable. I also acknowledge that any charitable donations will have 4.97% withheld from the donation to pay credit card and administrative costs.
Race Entry and its partner Alive Cubed shall not be liable to you for any direct, indirect, special, incidental, consequential or exemplary damages including, but not limited to, loss of profits, goodwill, use, data or other intangible loses. Race Entry and its partner Alive Cubed does not guarantee the completeness or accuracy of any information contained in, or provided in conjunction with the http://www.raceentry.com website. Race Entry and its partner Alive Cubed is not responsible for any omissions or inaccuracies, or for the results obtained from this information.
Race Entry and its partner Alive Cubed facilitates registration for various events, some of which allow participants under the age of thirteen (13). We require a submission of birth date for all registration entries. For children under the age of thirteen (13), parental or guardian consent is required.
You agree that the statutes and laws of the State of Utah, USA, will apply to all matters relating to this Agreement and Waiver. You irrevocably consent that exclusive jurisdiction for any dispute with Race Entry and its partner Alive Cubed relating to this Agreement and Waiver resides in the courts of Utah, and you further agree and expressly consent to the exercise of personal jurisdiction in the courts of Utah in conjunction with any such dispute including any claim involving Race Entry and its partner Alive Cubed.
