Women's Health Expo
CHI Health Missouri Valley
5K/1M Fun Run and Walk Registration

* 6. RELEASE FORM - YOU WILL BE SIGNING THE FORM ON BEHALF OF YOURSELF AND FOR ANYONE UNDER 18 THAT YOU REGISTER.

In consideration of the acceptance for entry in the above  event, I hereby freely agree to and make the following  contractual representations and agreements: 

I agree to enter this activity of my own free will and choice, and by doing so acknowledge that I am physically able to participate. 

I fully realize the dangers of participating in a running or walking even and  fully assume the risks associated with such participation, including by way of example: the dangers of injury from other pedestrians, vehicles, other participants and fixed or moving  objects; the dangers arising from surface hazards and weather conditions;  and the possibility of serious physical and/or mental trauma or injury associated with the 5K/1M Fun Run and Walk. 

I understand that this event will be held on school property and on public roadways, and I agree to follow all posted rules and regulations, including, but not limited to, stop signs, traffic etiquette such as right of way, and pedestrian laws of this jurisdiction.

I hereby waive, release and discharge for myself, my heirs,  executors, administrators, legal representative, assigns,  and successors in interest (hereinafter collectively  “successors”) any and all rights which I have or which may hereafter accrue to me against the sponsors of this event,  the city of Missouri Valley, IA, and any promoting  organization(s), property owners, law enforcement  agencies, all public entities, special districts, and properties  (and their respective agents, officials, and employees),  through or by which the events will be held for any and all  damages which may be sustained by me directly or  indirectly in connection with the event, or travel to or return  from the event. 

I agree it is my sole responsibility to be familiar with the  event course, and any special rules and regulations of the  event. I understand and agree that situations may arise  during the event which may be beyond the immediate  control of the event officials or organizers.  I have no physical or medical condition which, to my  knowledge, would endanger myself or others if I participate  in this event, or would interfere with my ability to participate  in this event. I agree, for myself and successors, that the  above representations are contractually binding, and are  not mere recitals, and that should I or my successors assert  my claim in contravention of this agreement, I or my  successors shall be liable for the expenses (including legal  fees) incurred by the other party or parties in defending,  unless the other party or parties are finally judged liable on  such claim for willful and wanton negligence. This  agreement may not be modified orally, and a waiver of any  provision shall not be construed as a modification of any  other provision herein or as consent to any other provision  herein or as consent to any subsequent waiver or  modification. 

If Parent or Guardian of a Minor: 
(I as a parent or guardian of the above named minor  hereby give my permission for my child or ward to  participate in the event, and further agree, individually  and on behalf of my child or ward, to the terms of the  above.)