I, {participantName}, declare I intend to participate in the Sole Mates walking program offered through the Alzheimer Society of Niagara Region (ASNR). I understand that this program is meant to be of a recreational nature and that each person has a different capacity to participate in this type of physical activity. I understand that part of the risk involved in undertaking any physical or recreational activity is relative to my own state of fitness or health. I understand that it is my responsibility to consult with a physician if I have any safety or health concerns prior to my participation in the Sole Mates program. I understand the program is not a supervised respite service and I must be able to independently participate. By signing this document, I warrant that I am physically fit and have no medical conditions that would prevent my participation in this program.
I understand that I must be able to walk safely in an outdoor environment. I understand that due to the outdoor nature of this program, precautions should be taken to protect myself including but not limited to wearing appropriate footwear, applying sunscreen, staying hydrated and being mindful of the walking path conditions and any potential trip and fall hazards. I understand that the Sole Mates walking program will not take place during inclement weather including but not limited to days with a humidex warning or rain and will be notified via email of any cancellations.
I understand that I am free to withdraw from, reduce or modify my involvement in today’s activities and realize I should do so upon recognition of any signs of light -headiness, fainting, chest discomfort, leg cramps, nausea and/or other symptoms.
I further understand that the ASNR personnel leading the Sole Mates program are not certified fitness instructors and cannot provide assessment or treatment of any physical disease or condition.
Indemnification
I, for myself, my heirs, executors, administrators, successors and assigns hereby release, waive and forever discharge Alzheimer Society of Niagara Region, and all other associations, sanctioning bodies and sponsoring companies and all their respective subsidiaries, agents, officials, servants, contractors, representatives, elected and appointed officials, successors and assigns, of and from all claims, demands, damages, loss, expenses, actions, causes of action, whether in law or in the said event whether as a participant or otherwise, whether prior to, during, or subsequent to the event and notwithstanding that same may have been contributed to or occasioned by the negligence of any of the aforesaid. I further hereby undertake to hold and save harmless and agree to indemnify all the aforesaid from and against all liability, incurred by any or all of them arising as a result of, or in any way connected with, my participation in the said event.
I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event.