All participants and volunteers must sign this waiver to participate in Outreach Health Services 5K Walk/Run race. Registration fee is $5.00 and is due before April 11th, and needs to be paid in the office at Outreach Health Services.

I know that running or volunteering for a road race is a potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained and, by my signature, I certify that I am medically able to perform in this event and that I am in good health while being properly trained.

I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend us participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event, including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic, and the conditions of the road, all such risks being known and accepted by me.

I understand that bicycles, skateboards, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and in consideration of your accepting my entry. I waive and release Outreach Health Services, Shubuta MS, Outreach Health Services Inc., all event sponsors and their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.

Signature / Parent/Guardian Signature (if under the age of 18)

FORM. PLEASE PRINT LEGIBLY

Waiver (MUST BE SIGNED)

In consideration of your accepting this entry, I, the below signed, intending to be legally bound, for myself, my heirs, my executors and administrators, waive and release and any all rights and claims for damages I may have against the race, and sponsors and their representatives, successors and assigns for any and all injuries suffered by me in said event. I attest that I will participate in this event as a footrace, that I am physically fit and sufficiently trained for the completion of this event. Furthermore, I hereby grant full permission to use my name and likeliness, as well as any photographs and any record of this event in which I may appear for any legitimate purpose, including advertising and promotion.