PROVIDENCE COLLEGE VOLUNTARY WAIVER FORM & PUBLICITY RELEASE
Assumption of Risk & Indemnity Agreement & Health Insurance Certification

NAMI Blue Jean Mile, 5/22/2026 6-8 p.m., Ray Treacy Track, Providence College

The undersigned requests (on behalf of him/herself or his/her child, if Participant is under 18 years of age) and is granted
permission to participate in an Activity at and/or sponsored by Providence College (the “College”) as described above. The
undersigned acknowledges and fully understands that there are or may be hazards and risks incident to participation in this
Activity, including risk of serious injury or death, and including losses that may result not only from the Participant’s own
action, inactions or negligence, but also from the actions, inactions, or negligence of others and/or from the condition of the
facility, fields, equipment, or areas where the Activity is being conducted, and/or related to the specific type of Activity, and
understands that the College assumes no responsibility of any nature whatsoever for the actions of Participant or any other
person or entity involved in this Activity.

In consideration for permission to participate in this Activity, the undersigned, on behalf of the Participant and his/her heirs,
executors, administrators, personal representatives, successors, and assigns, releases, forever discharges, and indemnifies
and holds harmless, the College, its trustee, administration, faculty, employees, staff, students, agents, successors, and
assigns (the “Releasees”) from and against any and all manner of action or actions, cause or causes of actions, suits, debts,
sums of money and all other claims and demands whatsoever in law or equity which Participant now has, or ever had, or in the
future may have, against the College, arising out of or in any way associated with, whether directly or indirectly, participation
in this Activity at and/or sponsored by the College, or for contribution or indemnification with respect to any claim made
against the Participant by any other person or entity in connection with the Activity.

The undersigned certifies that the Participant is in good health and has no physical condition that would prevent participation
in this Activity. The undersigned certifies that the Participant is covered by a health insurance plan for any injury or accident
that may occur while participating in or in conjunction with this Activity and that such insurance plan shall constitute the
medical coverage for treatment if an accident or injury occurs. The undersigned understands and agrees that the College
does not assume responsibility for the payment of health care not covered by the Participant’s health insurance plan.
Participants who are students of the College understand that the College’s Student Health Center may not be able or
equipped to provide medical care for any injury resulting from participation in this Activity. In the event that the Participant
requires emergency medical treatment, the undersigned hereby consents to such emergency treatment.

The undersigned also grants full permission to the College and its Releasees to forever use, copyright or publish, in any form,
photographs, videos, audios or quotations from Participant for any lawful purposes, including but not limited to, promotion
of the Activity, without compensation.

The undersigned understands that the release and hold harmless provisions contained in this Waiver Form are intended to be
as broad and inclusive as permitted by the laws of the State of Rhode Island. Participant agrees that if any portion of this
Waiver Form is held invalid, the remainder will continue in full legal force and effect. Participant further agrees that the
exclusive venue for any legal proceedings shall be in the State of Rhode Island and that the terms of this Waiver Form are
contractual and not a mere recital.

I HAVE CAREFULLY READ THIS WAIVER FORM, UNDERSTAND ITS CONTENTS, AND SIGN IT WITH FULL KNOWLEDGE OF ITS
SIGNIFICANCE.