I, or my minor child, desires to participate in the Poiont Breeze 5K (“Run”) organized by the City of Philadelphia (“City”). In consideration of the opportunity to do so, I agree as
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1. Release. I, for myself or my child if under 18 years of age, and for my heirs, successors, and assigns, and
all persons claiming through any of them (“Releasing Parties”) do hereby release the City, its officials,
departments, agencies, agents, representatives, boards, commissions, employees, successors and assigns
(“Released Parties”), from any action, causes of action, suits, claims, liabilities, losses, costs and expenses
(including reasonable attorneys fees and court costs), at law or in equity, which any of the Releasing Parties
may have against the Released Parties for any loss, damage or injury to property or person, including death,
relating to or arising from my participation in the Run; provided however, that this release shall not apply
to any action, causes of action, suits, claims, liabilities, losses, costs and expenses (including reasonable
attorneys fees and court costs), at law or in equity, which arise solely from the gross negligence or willful
misconduct of the Released Parties.
2. Assumption of Risk. I voluntarily assume all risks of loss, damage and all injuries (including personal
injury, disability and death) that may be sustained by myself and/or my minor child/ward or that I or my
minor child may cause while participating in the Run. In the event that I or my minor child suffers an injury
or illness in the Run that requires immediate medical attention, I understand that I/my minor child will
immediately be taken to the nearest hospital where the required medical attention will be given.
3. Visual Image/Photo Authorization. I authorize, without compensation, the use by the City of my image
and/or voice recordings relating to and occurring during the period of my participation in the Run. This
authorization includes permission to reproduce, publicize, broadcast or display my visual images or voice
recordings, with or without my name, and without any form of compensation for the use of my images,
name or voice recordings, throughout the world, an unlimited number of times in perpetuity in any and all
media, now known or hereafter invented.
I ACKNOWLEDGE THAT I AM EIGHTEEN (18) YEARS OF AGE OR OVER AND HAVE READ THIS
RELEASE FORM AND FULLY UNDERSTAND ITS TERMS, AND AGREE TO SIGN IT
Print Name Date Sign Name Date
PARENT/LEGAL GUARDIAN WAIVER FOR MINORS (UNDER 18 YEARS OLD)
THE UNDERSIGNED PARENT OR LEGAL GUARDIAN DOES HEREBY REPRESENT THAT ACTING
IN SUCH CAPACITY, HE/SHE HAS CONSENTED TO HIS/HER CHILD OR WARD’S
PARTICIPATION, AND HAS AGREED INDIVIDUALLY AND ON BEHALF OF THE CHILD OR
WARD, TO SIGN IT VOLUNTARILY.
Name of Child/Ward: __________________ Age: _______
Parent or Legal Guardian's Signature: __________________________________ Date:___________