Activity: Florence Neal Cooper Smith 5k

PLEASE PRINT.

Participant Information

In signing the Acknowledgement of Risk and Waiver Liability I hereby acknowledge and represent: (a) that I have read this document in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.

--------------------------------------------------------------------------

REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE: PARENT OR GUARDIAN’S AUTHORIZATION FOR MEDICAL CARE AND CONSENT AGREEMENT.

I certify that I am the parent or legal guardian of the above-named participant in the Florence Neal Cooper Smith 5k. On behalf of myself and my spouse, partner, co-guardian or any other person who claims the participant as a dependent, I have read the above agreement, I understand the contents of this Acknowledgement of Risk and Waiver of Liability, assent to its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability of my own free act. I acknowledge that my dependent and I have agreed to the terms and conditions of my dependent’s participation in the Florence Neal Cooper Smith 5k, and I hereby give my consent to participation by my dependent in the Florence Neal Cooper Smith 5k, and to receive medical treatment determined to be necessary. I further agree to hold harmless, indemnify and defend the F.A.C.T.S. Committee from and against all claims, demands or suits that my dependent has or may have.