Legacy Heart Walk
The Legacy Heart Walk is more than a walk—it’s a chance to honor the past, celebrate life, and invest in a healthier future for our city. By registering, you’re joining a movement of community, faith, and wellness that brings families together to raise awareness for heart health.
Section I: Participant Information
Indemnification, Assumption of Risk, and Release of Liability Agreement. Please complete the required information below.
Participant Name:
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First Name
Last Name
Date of Birth:
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Month
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Day
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
E-mail:
*
example@example.com
Emergency Contact
In the event of an incident, please provide an authorized person to contact.
Emergency Contact Name:
*
Emergency Contact Number:
*
Please enter a valid phone number.
Section II: Health and Medical Information
Please answer honestly and check where applicable. This information is strictly confidential and will be used to ensure your safety.
Medical Clearance
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I "have" consulted with my physician and I am cleared to participate in moderate physical activity, such as walking and light exercise.
I have "not" consulted with a physician and I "am" able to participate safely.
Section III: Acknowledgement of Risk
I understand and acknowledge that participating in the Legacy Heart Walk involves inherent risks. I fully acknowledge these risk and waiver any form of liability.
I understand that participation in this walk involves physical activity, and I voluntarily assume all risks, including but not limited to:
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Slips, trips, or falls on uneven terrain.
Sprains, strains, or muscle injuries.
Dehydration, heat exhaustion, or sunburn.
Allergic reactions to environmental factors (insects, pollen, etc.)
Unexpected medical emergencies.
Traffic-related hazards when crossing streets or walking near vehicles.
I, further acknowledge:
Participation is voluntary and I am personally responsible for monitoring my physical condition during the event.
It is my responsibility to stay hydrated, take breaks when needed, and withdraw from participation if I feel unwell.
Section IV: Assumption of Responsibility
I fully understand this agreement to participant in the Legacy Heart Walk and/or event activities. By checking each box, I agree to the terms of participation.
I waive liability and assumption of responsibility which includes but not limited to:
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Assume all risks associated with my participation, whether known or unknown.
I release and discharge EMperfected Beauty, the Legacy Heart organizers, volunteers, and any associated businesses or non-profit partners from any and all liability, claims, demands, actions, or causes of action arising out of my participation in this event.
I, agree, to indemnify and hold harmless the organizers against any claims or costs (including medical, legal, or insurance expenses) that may result from my participation.
Acknowledge media consent
I, acknowledge and grant permission, for my image, voice, or likeness captured during the event to be used for promotional or educational purposes without compensation or liability claims.
By checking each box, I agree to the terms of participation.
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I grant permission for photographs, audio, and video to be collected and used for promotional or educational purposes.
Guardian Agreement
If the participant named above is under 18 years of age, please complete the following:
Guardian Name:
First Name
Last Name
Guardian's Phone Number:
Please enter a valid phone number.
By checking each box, I agree to the terms of participation.
*
I grant permission for photographs, audio, and video to be collected and used for promotional or educational purposes.
Section V: Participant Agreement
I have carefully read and fully understand this agreement. I voluntarily sign it, acknowledging that by doing so I am waiving certain legal rights, including the right to sue the organizers.
Signature
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Date
*
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Month
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Day
Year
Date
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