Dental Dash 5k

Please join us for our first Virtual Race to help support ADHA- CT in our fundraising efforts. We are a non profit organization raising funds for dental /dental hygiene professionals to promote continuing education courses, community outreach programs as well as scholarship opportunities for dental hygiene students!

RUNNING EVENT WAIVER FORM (signature required) This form is for the 5k Dental Dash running events. I know that running is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I hereby certify that I am in good health and I have trained to run the distance of the race, which I am entering. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and the conditions of the roads, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry into this running race, I, for myself and anyone entitled to act on my behalf, waive any and release ADHA CT, it’s officers, directors, agents, volunteers and employees, all states, cities, counties, the metropolitan District Commission or other government bodies or locations in which events or segments of events are held, all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of the event for any legitimate purpose. I understand that bicycles, skateboards, roller skates or in-line skates and animals are not allowed in the event and I will abide by this policy. I also understand that baby joggers are discouraged for the safety of all participants. I am aware that the organization strongly discourages the use of personal audio devices (iPods and MP3 headsets) I authorize any healthcare provider to release any and all information pertaining to my healthcare, medical condition and medical treatment as a result of my participation in this 5k Dental Dash event to the American Dental Hygienist’s Association-Connecticut and it’s staff. Print Name Signature Date SecureFee™ Registration Cancellation Insurance is offered in most states. If purchased, your registration may be covered for one of the covered reasons stated in the policy.