Form

Black Physicians of Utah Event Waiver and Release Form
Name

First NameLast Name
Email
example@example.com
In consideration of you accepting this entry, endorsed by Black Physicians of Utah, I, the undersigned participant, acknowledge and agree to the following terms: I understand that participation in physical activity, including walking, running, or related event activities, may involve risks of injury, property loss, or worse. I voluntarily assume full responsibility for any risks associated with my participation. I hereby waive, release, and forever discharge Black Physicians of Utah, its officers, event directors, volunteers, agents, partners, sponsors, and all others involved in the organization of the event from any and all claims or liabilities, including personal injury, illness, property damage, or other loss that may arise before, during, or after this event. I affirm that I am medically able and properly trained to participate in the activity for which I have registered. I further certify that I have not been advised otherwise by a qualified medical professional. I understand that it is my responsibility to listen to my body, hydrate appropriately, and take all necessary precautions. In case of a medical emergency, I authorize the Event Director or designated event personnel to seek emergency medical care and/or treatment on my behalf. I agree to assume full responsibility for any and all related costs. I grant permission for Black Physicians of Utah to use my name, image, likeness, or voice in any photographs, video recordings, media coverage, or promotional materials associated with the event, without expectation of compensation. I understand and agree that all entry fees are non-refundable, even in the case of postponement or cancellation due to circumstances beyond the control of the organizers, such as severe weather, public safety concerns, or public health emergencies. Event details are subject to change without notice. By signing below or submitting this waiver digitally, I confirm that I have read, understand, and agree to all the terms outlined above.

Black Physicians of Utah Event Waiver and Release Form