Waiver

First Name:                                                                        Last Name:

Sex:                                                                                   Birthdate:

City, State, Zipcode:                                                         Street Address/P.O. Box:                                  

Phone (h):                                                 

Health insurance for the day of the event                     yes               no

Accident insurance for the day of the event                 yes                no

Name, address and telephone number of relative or friend (who will not be present at the event):

I have the following medical or physical condition(s) which should be noted by the Event Directors, as they may affect my ability to safely take part in this event. Please list any medications that you are routinely taking:

 

WAIVER OF LIABILITY - ASSUMPTION OF RISK

I do hereby release and discharge the Event Directors and any and all persons assisting in the „Winter Trails 50 Miles” and their respective representatives, whether compensated or uncompensated, of any and all liability arising from any and all illness, injuries, and damages I may suffer as a result of my participation in this event. This waiver of liability and assumption of risk specifically includes, but is not limited to, any liability resulting from:

(1) Availability or inadequacy of aid stations;

(2) Availability or inadequacy of traffic control;

(3) Failure to warn of hazards on the course;

(4) Failure to have adequate pick up crews to assist walkers who are lost or develop difficulties;

(5) Failure to provide or inadequacy of medical support and facilities.

I further state that I am in proper physical condition to participate in this event and suffer from no medical conditions that would put me at risk for injury or death as a result of my participation in this event. Alternatively, I assume the full risk for any death or injury that occurs as a result of any such condition and my participation in this event. I am participating in this event as a recreational event in which I will maintain a safe lookout at all times and assume the risk for any traffic or hazards encountered during the event.

By my signature hereto, I acknowledge that I have read the above waiver of liability and assumption of risk and that I concur in its entirety.

I have read all event related information on the webpage http://www.ultrawalk.com and agree with everything stated in it.

 

Signature: _________________________ Date: ___________