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RELEASE AND WAIVER OF LIABILITY FORM FOR PUSHING PAST AUTISM 2008
In consideration of being permitted to participate in Pushing Past Autism 2008, the undersigned (“Participant”) forever releases and holds harmless the organizers, associates, beneficiaries, fellow participants, volunteers, sponsors, advertisers and any other person or entity involved with Pushing Past Autism 2008 from any liability whatsoever for any kind of harm, damage, loss, or expense suffered or incurred by the Participant as a result, directly or indirectly, of the Participant’s preparation for and participation in Pushing Past Autism 2008 and, in doing so, the Participant fully waives any rights the Participant may have now or in the future to bring a claim or action related to the same.
The Participant understands and acknowledges that any physical activity is potentially dangerous and may result in injury or permanent disability, and the Participant fully assumes all risks related to the Participant’s preparation for and participation in Pushing Past Autism 2008.
BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTOOD THE TERMS OF THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT, AND I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
FULL LEGAL NAME OF PARTICIPANT: ________________________________________________
(PLEASE PRINT)
DATE OF SIGNING: _______________________________________
PARTICIPANT’S SIGNATURE : _______________________________________
(IF 18 YEARS OF AGE OR OLDER)
FOR PARTICIPANTS UNDER THE AGE OF 18:
FULL LEGAL NAME OF PARENT OR LEGAL GUARDIAN :
(PLEASE PRINT) _______________________________________
I, THE PARENT OR LEGAL GUARDIAN OF THE PARTICIPANT NAMED ABOVE, UNDERSTAND AND AGREE TO THE TERMS OF THIS DOCUMENT ON BEHALF OF THE PARTICIPANT.
DATE OF SIGNING: _________________________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN:
_________________________________________
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