Register For
Heart of a Lion 5K Run/Walk *All proceeds benefit the Jackson Area 19 SPECIAL OLYMPICS*

Jackson, MI 49203

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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Used for age group calculations
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$25.00

$25.00

Waiver

In consideration of you accepting this entry, I, the participant, intending to be legally bound and hereby waive or release any and all right and claims for damages or injuries that I may have against the Event Director, RunSignup.com, and all of their agents assisting with the event, sponsors and their representatives and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. I also authorize the use of photographs or videos that include my image for promotional, informational, or other reasons deemed to be in the best interest of the event.

I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that my physical condition has been verified by a licensed Medical Doctor. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above waiver.  

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT
FOR COMMUNICABLE DISEASES
(“Agreement”) for
SPECIAL OLYMPICS
In consideration of being allowed to participate in any way in Special Olympics sports training, competition or fundraising
activities, the undersigned acknowledges, appreciates, and agrees that:
1.
Participation includes possible exposure to and illness from infectious and/or communicable diseases including but not
limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk
of serious illness and death does exist; and,
2.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM
THE
NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3.
I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection
against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or
participation, I will remove myself from participation and bring such to the attention of the nearest official immediately;
and,
4.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND
HOLD HARMLESS Special Olympics, Inc, Special Olympics Michigan, their officers, officials, agents, and/or
employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises
used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or
loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT,
AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name of Participant:
Participant Signature:
Date signed:
_______________________________________________
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the
provisions
in this waiver/release to my child/ward including the risks of presence and participation and his/her personal
responsibilities for
adhering to the rules and regulations for protection against communicable diseases. Furthermore, my
child/ward understands
and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and
agree to his/her release
provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to
indemnify and hold
harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or
participation in these activities
as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent
provided by law.
Name of parent/guardian:
Parent guardian/signature:
Date signed:
Special Olympics Michigan
Central Michigan University, Mt. Pleasant, MI 48859
Phone:
800-644-6404
Fax:
989-774-3034
www
.somi.org
Email:
somi@somi.org
Facebook
SpecialOlympicsMichigan
Twitter & Instagram
@SpOlympicsMI
Created by the Joseph P. Kennedy Jr. Foundation for the benefit of persons with intellectual disabilities

 




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