REQUIRED TO SIGN WHEN PICKING UP REGISTRATION PACKAGE
WAIVER AND RELEASE OF LIABILITY
IN CONSIDERATION OF the risk of injury that exists while participating in RACE (hereinafter the "Activity"); and
IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same;
I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively,
"Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age),
knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or
causes of action of any kind arising out of my participation in the Activity; and
I HEREBY release and forever discharge THORNE TO ROSE FOUNDATION, located at P O Box 257, Rolesville, North
Carolina 27571, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives,
predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer
as a direct result of my participation in the aforementioned Activity.
I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE
ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS
ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN,
SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS),
ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY
ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE
ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED
RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.
I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any
kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's
fees and any related costs.
I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or
entity conducting a specific event or activity on behalf of Releasees. In the event that I should require medical care or
treatment, I authorize Thorne to Rose Foundation to provide all emergency medical care deemed necessary, including but not
limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical
personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a
result of such treatment. I am aware and understand that I should carry my own health insurance.
I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with
it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able
and properly trained, and I agree to abide by the decision of the Thorne to Rose Foundation official or agent, regarding my
approval to participate in the Activity.
I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY
UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Thorne
to Rose FoundationAND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF,
VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL
CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I
OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Thorne to Rose Foundation FOR PERSONAL INJURY OR
PROPERTY DAMAGE.
To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such
negligence on the part of Thorne to Rose Foundation, its agents, and employees.
I agree that this Release shall be governed for all purposes by North Carolina law, without regard to any conflict of law
principles. This Release supersedes any and all previous oral or written promises or other agreements.
In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions,
neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of
neglect or recklessness.
THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION
IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.
THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement
between two parties of equal bargaining strength. Both Participant, _________________________ and Thorne to Rose
Foundation agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or
admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance
with the purposes for which it is entered into.
In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any
term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the
remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to
be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall
be deemed to be written, construed and enforced as so limited.
In the event of an emergency, please contact the following person(s) in the order presented:
Emergency Contact Contact Relationship Contact Telephone
I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM
FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY
UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS
IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WILL.
Participant's Name:
Participant's Address:
Signature:
Date:
PARENT / GUARDIAN WAIVER FOR MINORS
In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or
guardian, as follows:
I HEREBY CERTIFY that I am the parent or guardian of
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, sponsors, affiliates, volunteers, Acts Now 5k Dash, and individual Acts Now 5k Dash 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 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 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 is not responsible for any omissions or inaccuracies, or for the results obtained from this information.
Race Entry 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 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 .