RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
FOR AND IN CONSIDERATION of the opportunity to participate in the event known as St. Joseph's 5K Run Walk offered by St. Joseph's Health Services, Inc., d/b/a Gundersen St. Joseph Hospital and Clinics, the undersigned, for himself or herself, and for his or her heirs, agents, executors, personal representatives, next of kin and assigns:
1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE St. Joseph's Health Services, Inc., the Event sponsors, promoters, participants, advertisers, owners and lessees of premises used to conduct the Event, together with their respective affiliates, trustees, directors, officers, agents, servants, employees and representatives (collectively referred to as "St. Joseph's"), FROM ALL LIABILITY, TO THE UNDERSIGNED, his or her personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF ST. JOSEPH'S OR OTHERWISE.
2. HEREBY AGREES TO INDEMNIFY, DEFEND, SAVE AND HOLD HARMLESS the ST. JOSEPH'S FROM ANY LOSS, LIABILITY, DAMAGE, OR COST the UNDERSIGNED may incur arising out of or related to the EVENT(S) WHETHER CAUSED BY THE NEGLIGENCE OF ST. JOSEPH'S OR OTHERWISE.
3. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the EVENT(S) whether caused by the NEGLIGENCE OF ST. JOSEPH'S or otherwise.
4. HEREBY acknowledges that THE ACTIVITIES OF THE EVENT(S) ARE POTENTIALLY DANGEROUS and involve the risk of serious injury and/or death and/or property damage.
5. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by St. Joseph's and is intended to be as broad and inclusive as is permitted by the laws of the State of Wisconsin in which the Event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
6. HEREBY allows photographs, videotapes or televising to be used for such subsequent publication, including but not limited to, newspapers, television, bulletin boards and St. Joseph's website as may be deemed appropriate by St. Joseph's or other persons responsible for the photography.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Signature of parent or
Guardian (if under 18): Date:
Witnessed by:____________________________________ Date: