Full Name: [Your Name]
Address: San Francisco, CA 94102
Phone Number: 222 555 7777
Email Address: [Your Email]
Date of Birth: April 24, 2050
Event Name: Fall Charity Run 2065
Event Date: October 15, 2065
Event Location: San Francisco, CA 94102
I, [Your Name], acknowledge that participation in the Fall Charity Run 2065 involves certain risks, including but not limited to, physical injury, property damage, or even death. I understand that these risks may be inherent to the nature of the event and accept full responsibility for any injury or damage that may occur.
In consideration for being allowed to participate in the Fall Charity Run 2065, I agree to release, discharge, and hold harmless GoWorld, its sponsors, and their respective officers, directors, employees, agents, and volunteers from all liability for any claims, demands, or causes of action arising out of or related to any injury, loss, or damage sustained during the event, whether caused by the negligence of the released parties or otherwise.
I understand that this waiver and release of liability is intended to be as broad and inclusive as permitted by the laws of California and that if any portion is held invalid, the remainder will continue in full force and effect.
IN WITNESS THEREOF, the participant has executed this release on the date first written above.
Releasor’s Signature: | Participant’s Signature: |
Coordinator October 10, 2065 |
Participant October 10, 2065 |
If the participant is under 18 years of age, a parent or guardian must also sign:
Johann Harvey
Parent/Guardian
October 10, 2065
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