First Name:

            City:

          State:

             Zip:

        Phone:

         Email:

Age On Race Day:

               Shirt Size:     Select One Youth Medium Youth Large Small Medium Large X Large

                     Event:  Select One 5K Run 2 Mile Walk

Liability Release and Parental Consent Form

In consideration of the acceptance of my application for the above activity, I hereby waive, release and discharge any and all claims for damages for personal injury, property damages or death which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance the city of Roy, its officials, officers, employees, volunteers and agents for liability, even though that liability may arise out of negligence on the part of persons for entitles mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that that this waiver, release and assumption of risk is to be binding on my heirs and assignees.

(Parent/Guardian): I hereby give my consent to have the above applicant treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that the Roy Recreation Complex, Roy Parks and Recreation Department and Roy City will provide no medical insurance for such treatment, and that the cost thereof will be at my expense.

I have read and understand the foregoing registration liability release and parental consent form, and agree to all of its terms and conditions.

    Waiver: Select Yes

Signature:    (parent or guardian if under the age of 18)

 

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