Thank you for your interest in attending LAC- Delta Sigma Theta Sorority, Inc. Regional Day of Service October 19, 2019.. Please fill out this survey to get registered.

Louisville Alumnae Chapter - Delta Sigma Theta Sorority, Inc. official Day of Service event is Sista Strut 3K Breast Cancer walk to be held on October 19 at Shawnee Park  at 8am.  Sista Strut  benefits Kentucky African American Against Cancer and Susan G Komen Foundation. 

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* 1. Will you be attending LAC- Delta Sigma Theta Sorority, Inc. Regional Day of Service October 19, 2019.?

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* 2. Are you a member of Delta Sigma Theta Sorority, Inc.

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* 3. How did you hear about LAC-DST participation in Sista Strut

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* 4. Are you between the ages of:

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* 5. Would you like to learn more about LAC- Delta Sigma Theta Sorority, Inc. current and future events ?

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* 6. How would you like to receive additional information about LAC- Delta Sigma Theta Sorority, Inc. events? Please complete the contact information to be included on our events calendar.

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* 7. Your contact info:

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* 8. Attending the Sista Strut with LAC-DST? Please accept or decline Photo/Audiovisual/Social  and Print Waiver of Liability.

RELEASE

Photo/Audiovisual/Social and Print Media
 
By participating in the Regional Day of Service (“RDOS”), I grant permission to Louisville Alumnae Chapter of Delta Sigma Theta Sorority, Inc., as well as the sponsors and partners of the RDOS, the perpetual right to publish in print, electronic, audio, or video format, the likeness, image, or voice of me. I further grant to all parties the perpetual right to any remarks attributed to me, either solicited or unsolicited, at its discretion, whether through their own facilities or those of other agencies or organizations to whom they subsequently grant use.

I  hereby consent that videotapes, photographs, and/or motion pictures film for which I posed, and/or audio recordings made of my voice may be used by, their assigns and successors, in whatever way they desire, including television; furthermore, I hereby consent that such photographs, films and recordings, and the plates and/or tapes from which they are made shall be their property, and they shall have the rights to sell, duplicate, reproduce, and make other uses of such photographs, films, recordings, plates and tapes as they may desire free and clear of any claim whatsoever on my part.

 

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* 9. Attending the Sista Strut with LAC-DST?  Please accept or decline the Waiver of Liability.

WAIVER OF LIABILITY
Louisville Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

1.  In consideration for participating in the Regional Day of Service (“RDOS”)  and other valuable consideration, I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE  Louisville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. (JASSAC) their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is being conducted or in transportation to and from said premises.

2.   To the best of my knowledge, I can fully participate in this activity.  I am fully aware of risks and hazards connected with the activity, including but not limited to the risks as noted herein, and I hereby elect to voluntarily participate in said activity, and to enter the above-named premises and engage in such activity knowing that the activity may be hazardous to me   and my property.  I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.

3.   I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any loss, liability, damage or costs, including court costs and attorney’s fees, that may incur due to my participation in said activity, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise.

4.   It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assigns and personal representative, if I am not alive, shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES.  I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Illinois.

5.   I UNDERSTAND THAT THE ABOVE PARTIES WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH AN INJURY I MAY SUSTAIN.

6.   I agree not to violate any directives or instruction made by the person or persons in charge of said activity and I will further assume the complete risk of any activity done in violation of any rule or directive or instruction.

7.   I also understand that I should and am urged by JASSAC to obtain adequate health and accident insurance to cover any personal injury to myself which may be sustained during the activity or the transportation to and from said activity.

8.   I also understand that I am responsible for any damage I cause to the facilities. IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.

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