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 ______________________________