First Name:

        Address:

               City:

             State:

                Zip:

Email (JMU):

Phone (Cell):

Age On Race Day:

               Event:        Select Event 5K Run 5K Walk

Assumption of Risk

Participation in the Alternative Break Program 5K Run/Walk is entirely voluntary, and participants may withdraw from the activity at any time. In determining whether you will participate in the activity, you should be aware that James Madison University cannot undertake financial responsibility for you or your personal property in the event that you are injured or your personal property is damaged or lost while participating in the activity.

In consideration of James Madison University permitting your participation in the activity, you must agree to assume the risks known to be inherent in the activity, as well as any unforeseeable risks. The known risks inherent in the activity are: your personal fitness level, falls, contact with other participants, the effects of the weather, including water, ice, or snow on the road surface, traffic and the conditions of the race route.

As is the case with many other activities in which you may engage, you should determine whether you or your family have health or accident insurance in effect to adequately cover you should you be injured while participating in this activity.

* * * * *

I have read and understand the foregoing explanation of the risk inherent in the voluntary activity. I am at least eighteen years of age, and it is my decision to participate in the activity, if accepted by James Madison University. I hereby accept the risk of injury to me and to my personal property as a result of participating in the activity, and, as further consideration for its permitting me to participate in the activity, I hereby release James Madison University from any and all claims which I may have against it for loss or damage to myself or my property resulting from my participation in the activity.

I understand that if I have any question about the foregoing at any time in the future, I must contact Dusty Krikau, who has sole authority in this matter.

Further, I hereby grant full permission to any and all of foregoing to use my name, photograph, videotapes, motion pictures recordings, or any other record of this event for legitimate purpose, without compensation or remunerations. I understand that bicycles, skateboards, roller skates or blades, animals and radio head sets are not allowed in the walk/run and I will abide by this guideline, I understand that if the walk/run is canceled due to circumstances beyond the control of the walk/run -commute, my entry fee will not be refunded.
 

Agree With Waiver: Select Yes

     Signature:    (Parents Signature required if under 18)

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