Clone of Legacy Heart Walk Registration & Liability Waiver

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:

First NameLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
Walk Together: Team Registration

Better health starts with one step—and it's even better when we take that step together. ❤️This year, we're encouraging families, friends, churches, businesses, organizations, fitness groups, and community partners to form a Legacy Heart Walk Team of four (4) or more participants and join us for at least one hour of fitness and fellowship. Teams may represent an organization, honor a loved one, support a cause, or simply walk together for better health!
Will you be participating as part of a team or group?
Team/Group Name:
Which best describes your team? Please select only "one" category.
Are you the Team Captain/Primary Contact?
Are you walking in Memory/Honor of Someone? If so, please share their name(s).
Section II: Health, Medical Information & Participant Safety

Our goal is simple: give our community an accessible opportunity to experience one hour of fitness and fellowship while increasing awareness about heart health.
Health and Medical Information

Your safety is important to us. The Legacy Heart Walk includes optional physical activities ranging from seated exercises and stretching to walking and running. Participation in all activities is completely voluntary and at your own risk. Legacy Heart Walk does not provide medical advice or determine whether an individual is medically fit to participate. Participants are responsible for selecting activities appropriate for their individual health, physical ability, and fitness level.
Do you currently have a medical condition, injury, physical limitation, or other health concern that could affect your ability to safely participate in physical activity?
If I have a known medical condition, injury, physical limitation, or other health concern, I understand that it is my responsibility to consult with a qualified healthcare professional when appropriate before participating.
By choosing to participate, I acknowledge that I have voluntarily determined that my selected activity is appropriate for me and/or that any known health condition affecting my participation is being appropriately managed or treated.
I understand that I should stop participating and seek appropriate assistance if I experience pain, dizziness, shortness of breath beyond normal exertion, chest discomfort, weakness, or other concerning symptoms..
Select your Fitness Level

All (3) experiences matter. There is no 'better' level. The victory is that YOU showed up and intentionally moved YOUR body. Please ensure that you wear proper clothing and shoes.
Fitness Experience (3 Levels)
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:
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:
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.
Guardian Agreement

If the participant named above is under 18 years of age, please complete the following:
Guardian Name:

First NameLast Name
Guardian's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
By checking each box, I agree to the terms of participation.
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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Legacy Heart Walk

Section I: Participant Information

Emergency Contact

Walk Together: Team Registration

Section II: Health, Medical Information & Participant Safety

Health and Medical Information

Select your Fitness Level

Section III: Acknowledgement of Risk

Section IV: Assumption of Responsibility

Acknowledge media consent

Guardian Agreement

Section V: Participant Agreement