***You must complete the waiver and emergency contact information***
*NOTE: George Hermann Western Illinois Senior Olympics strongly recommends that each participant consult his or her doctor in regard to practice, participation, and competition in this program or in any similar physical activity.
Waiver and Release of All Claims
Please read this form carefully and be aware that in signing up and participating in the George Hermann Western Illinois Senior Olympics, you will be waiving and releasing all claims for injuries you might sustain arising out of your participation in this competition.
George Hermann Western Illinois Senior Olympics
As a participant in the George Hermann Western Illinois Senior Games, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries (including death), damages or loss which I may sustain as a result of participating in any and all activities connected with or associated with such competition.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, agree to waive and relinquish all claims I may have as a result of participating in the competition against the George Hermann Western Illinois Senior Olympic Board, officials, volunteers, and sponsors at all participating sites, the Board of Trustees of Western Illinois University, its officers, agents, servants, and employees from any and all claims from injuries (including death), damages or loss which I may have or which may accrue to me on account of participating in the competition.
I further agree to indemnify and hold harmless and deem the George Hermann Western Illinois Senior Olympics Committee, officials, volunteers, and sponsors at all participating sites, the Board of Trustees of Western Illinois University, its officers, agents, servants, and employees from any and all claims resulting from injuries (including death), damages, and losses sustained by me or arising out of, connected with, or anyway associated with the activities of the program.