Register For
16th Aching Quad Challenge - presented by MIDFLORIDA Credit Union

Lakeland, FL 33803

Registrant #1

Who are you registering? *


By selecting this box, you are indicating that you are the parent/guardian of the person you are about to register. Additionally, if the child is under the age of 13, you are consenting to the collection and use of the information about the child for the purpose of the registration as described in our privacy policy.

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Additional Information

Format: mm/dd/yyyy
Used for age group calculations
Format: ###-###-####

Address

Choose Your Event(s) *

5k + 1 mile + 2 mile + 5k
Friday October 8, 2021 - Saturday October 9, 2021

$55.00 $45.00 + $3.61 SignUp Fee

There is an inherent risk of exposure to COVID-19 in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and persons with underlying medical conditions are especially vulnerable. If you choose to participate in the Aching Quad Challenge, you voluntarily assume all risks related to exposure to COVID-19.

Registrants for the 4 Race Challenge receive:
• Four Chip Timed Races
• Participant Shirt
• Finisher Medal
• Eligible for Challenge Overall & Age Group Awards

Waiver

I know that walking, running in, and/or volunteering for the Aching Quad Challenge (the “Event”) is a potentially hazardous activity, which could cause injury or death. I will not enter and participate in the Event unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this Event, and I am in good health and I am properly trained. I agree to abide by all rules of the Event, including the right of any official to deny or suspend my participation in the Event for any reason whatsoever. I attest that I have read the rules of the Event and agree to abide by them. I assume all risks associated with participating in this Event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat, humidity, rain, and/or lightning, traffic and the conditions of the road, automobiles, fractures, cuts, uneven ground and/or running surfaces, sprains, strains, bicycles, strollers, animals (wild or domesticated), food poisoning, other participants, spectators, volunteers, road surface conditions, sidewalk surfaces, bridge surfaces, cones, and start/finish line mats, all such risks being known and appreciated by me. I understand that skateboards, roller skates or roller blades, and animals, are not allowed to be used in the Event, and I agree to abide by this rule. Items discouraged due to safety concerns are bicycles, baby joggers and personal music players.

I acknowledge there is an inherent risk of exposure to COVID-19 in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and persons with underlying medical conditions are especially vulnerable. By participating in a race, I voluntarily assume all risks related to exposure to COVID-19.

Having read this waiver and knowing these facts and in consideration of your accepting my entry and entry fees, I, for myself and any minors I registered for this Event, my heirs, assigns, executors, administrators, and anybody else entitled to act on my behalf, agree to waive, release, and hold harmless the Lakeland Runners Club, Inc., the City of Lakeland, RunSignUp.com, LLC, the Road Runners Club of America, all event sponsors, volunteers, officials, venders, organizers of the Event, and all of the foregoing’s representatives, affiliates, directors, volunteers, employees, and successors (the “Releasees”) from all claims or liabilities of any kind arising out of my participation in the Event, even though that liability may arise out of the negligence or carelessness on the part of the Releasees named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record for any legitimate promotional purpose.

HOLLOWAY PARK WAIVER OF LIABILITY AND ASSUMPTION OF RISK
In Consideration of the right to participate in the Event referred to above (hereinafter referred to as “Event”), the
undersigned, individually and on behalf of my minor (if applicable), hereby acknowledge(s) and agree(s) that they
understand the nature of the Event; that Participant is qualified, in good health, and in proper physical condition to
participate therein; that there are certain inherent risks and dangers associated with the Event; and that, except as
expressly set forth herein, they, knowingly and voluntarily, accept, and assume responsibility for each of these risks and
dangers, and all other risks and dangers that could arise out of, or occur during, Participant’s participation in the Event.
The undersigned hereby acknowledges that they are in sufficient physical shape and condition to participate in the Event
and that the Participant has the property and appropriate skill level and training to participate in the Event. Release and
Waiver: The undersigned, individually and on behalf of my minor (if applicable), hereby RELEASE, WAIVE, DISCHARGE AND
COVENANT NOT TO SUE the Releasees identified above, and its member institutions, or any subdivision thereof, and each
of them, their officers and employees, (collectively, the “Releasees”), from and for any liability resulting from any personal
injury, accident or illness (including death), and/or property loss, however caused, arising from, or in any way related to,
Participant’s participation in the Event, except for those caused by the willful misconduct or intentional torts of the above
parties, as applicable. Indemnification and Hold Harmless: The undersigned, individually and on behalf of my minor (if
applicable), also hereby agree to INDEMNIFY, DEFEND AND HOLD the Releasees HARMLESS from any and all claims,
actions, suits, procedures, costs, expenses, damages and liabilities including, but not limited to, attorney’s fees, arising
from, or in any way related to, Participant’s participation in the Event, except for those arising out of the willful misconduct
or intentional torts of the above parties, as applicable. Permission to Use Likeness/Name: The undersigned, individually
and on behalf of my minor (if applicable), further agree to allow, without compensation, Participant’s likeness and/or
name to appear, and to otherwise be used, in material, regardless of media form, promoting Holloway Park Foundation,
Inc., and/or its championships, events and activities, including those of its representatives and licensees. Severability: The
undersigned, individually and on behalf of my minor (if applicable), expressly agree that the foregoing agreement is
intended to be as broad and inclusive as is permitted by the law of the State of Florida and that if any portion thereof is
held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Acknowledgment
of Understanding: The undersigned, individually and on behalf of my minor (if applicable), have read this agreement, and
have had the opportunity to ask questions about the same. The undersigned, individually and on behalf of my minor (if
applicable), fully understand this agreement, that the undersigned are giving up substantial rights in connection therewith,
and that its terms are contractual, and not a mere recital. The undersigned, individually and on behalf of my minor (if 
applicable), acknowledge that they are signing this agreement freely and voluntarily. This agreement shall be governed
by the laws of the State of Florida and the Polk County Court shall be the appropriate venue and jurisdiction for any
disputes which may arise in relation to this agreement. The Participant hereby specifically waives a Trial by jury in relation
to any dispute with Releasees and this agreement.

MEDICAL AUTHORIZATION
I understand that in the event medical intervention is needed, I hereby authorize any medical treatment, first aid,
assistance, emergency first aid, surgical procedure or dental assistance and hereby authorize the dispensation of or
injection of anesthesia, medicines, x-rays, or surgery as deemed necessary by any attending emergency personnel. The
undersigned, individually and on behalf of my minor (if applicable), shall be liable and agrees to pay all costs and expenses
incurred in connection with such medical and dental services rendered pursuant to this authorization. I hereby
acknowledge and agree that that the Releasees shall have no duty, obligation or liability arising out of the provision of, or
failure to provide, medical treatment.

PERMISSION TO USE NAME/PUBLICITY RIGHTS
The undersigned, individually and on behalf of my minor (if applicable), hereby grant to the Releasees the right to
photograph, record, videotape or otherwise record my image, voice and likeness. The undersigned, individually and on
behalf of my minor (if applicable), hereby agrees to allow, without compensation, the Releasees the right, to display,
publish, disseminate, use, and advertise and otherwise use said photographs, records, videotapes likeness or image
forever and throughout the world in all media in perpetuity whether in writing, television, cable, print or other media
without compensation to the Participant.

COVID-19 WAIVER
The novel coronavirus, known as COVID-19, is an extremely contagious virus, which can cause serious medical conditions,
including death. COVID-19 has been declared a worldwide pandemic by the World Health Organization, and as a result,
federal, state, and local governments along with federal and state health agencies recommend social distancing and have,
in some circumstances, limited the congregation of people. COVID-19 is so contagious that even the most extraordinary
measures have not halted its spread. The Releasees cannot guarantee that you will not contract the virus while
participating in or attending an Event. The increased exposure of attending or engaging in an Event could increase your
risk of contracting COVID-19. The undersigned, individually and on behalf of my minor (if applicable), voluntarily agrees
to assume all of the foregoing risks and accept sole responsibility for any injury to myself or my minor (including, but not
limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my
minor may experience or incur in connection with attendance or participation at an Event. On my behalf, and on behalf
of my minors, I hereby release, covenant not to sue, discharge, and hold harmless all of the Releasees of and from any
claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I
understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Releasees,
whether a COVID-19 infection occurs before, during, or after attendance or participation in any Event.




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