running club

Running Club Participation Waiver

Email Address:

First Name:

Middle Name:

Last Name:

Address 1:

Address 2:

City:

State or Province:

Zip or Postal Code:

Home Phone:

Cell/Mobile Phone:

Birth Date:

Gender:

Are you over 18?:

Emergency Contact:

Emergency Phone Number:

I have read and agree to the following waiver.

Waiver Agreement:

	Yes
	No

Waiver:

ALL PARTICIPANTS IN THE SEE JANE RUN RUNNING CLUB AND RELATED EVENTS AGREE TO ASSUME ALL RISK OF PARTICIPATION IN THE SEE JANE RUN RUNNING CLUB AND OTHER SEE JANE RUN RELATED EVENTS BY SIGNING THIS GENERAL RELEASE AGREEMENT.

The undersigned athlete ("Athlete") on behalf of himself/herself and on behalf of Athlete's personal representatives, assigns, heirs, executors, hereby fully and forever releases, waives, discharges and covenants not to bring any legal action or seek to hold liable Jane’s World Inc. d.b.a. See Jane Run, its officers, and employees, race officials, race volunteers, states, cities, towns, and other governmental bodies and locations in which the See Jane Run Running Club or portions of the See Jane Run Running Club take place, and the officers, directors, employees, agents, insurers, other participants and representatives of all of the above, any or all of the charities affiliated with the See Jane Run Running Club all municipal agencies whose property and/or personnel are used and all other sponsoring or co-sponsoring companies, organizations, or individuals related to the See Jane Run Running Club and related events, and the directors, officers, affiliates, employees, representatives or other relations to such entities (collectively, the "Releasees"), from all liability to the Athlete and his/her personal representatives, assigns, heirs and executors, for all loss(es) or damage(s) and any and all claims of demands therefore, on account of injury to the Athlete or property or resulting in the death of the Athlete, whether caused by the active or passive negligence of all or any of the Releasees or otherwise, in connection with the Athlete's participation in the See Jane Run Running Club and related events.

The Athlete represents and warrants that he/she is in good physical condition and is able to safely participate in the See Jane Run Running Club and/or related events. The Athlete is fully aware of the risks and hazards inherent in participating in the See Jane Run Running Club and/or any related events, knowing the risks associated with the See Jane Run Running Club and/or any related events. The Athlete hereby assumes all risks of loss(es), damage(s), or injury(ies) that may be sustained by him/her while participating in the See Jane Run Running Club and/or any related events. The Athlete agrees to permit the use of his/her name, voice, picture, or photograph, in any broadcast, telecast, commercial advertisement, promotion, brochures, and other media without compensation and without notice and I waive any rights to future compensation to which I might otherwise have been entitled for such use by Jane’s World Inc. The athlete acknowledges that providing their email address on the entry form entitles the See Jane Run to email him/her related topics. The Athlete acknowledges that the entry fee is non-refundable and non-transferable. The Athlete hereby grants to the medical director of the See Jane Run Running Club and/or related events, and their agents, affiliates and designees access to all medical records (and physicians) as necessary and authorizes medical treatment as needed. The Athlete warrants that all statements made herein are true and correct and understands that Releasees have relied on them in allowing Athlete to participate in the See Jane Run Running Club and/or related events.

IF ATHLETE IS UNDER AGE 18: The parent/guardian certifies that my son/daughter has my permission to participate in the See Jane Run Running Club and/or any related events. The parent/guardian has read the forgoing RELEASE AND WAIVER OF LIABILITY AGREEMENT and by accepting the waiver intentionally and voluntarily agrees to its terms and conditions. The parent/guardian further certifies that my son/daughter is in good physical condition and is able to safely participate in the See Jane Run Running Club and/or any related events. The parent/guardian authorizes medical treatment for my son/daughter as needed and grants access to my child's medical records as necessary.

Waiver Season:

{upcoming event}

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