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Aid Station
   Sunday, January 13, 2013 (07:00 PM - 10:00 PM)

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* First Name:
* Last Name:
* Address:
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* Zip/Postal Code:
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* Gender Female Male
* Date of Birth:  
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Work Phone:
*What size T-shirt would you like?:
*Occupation?:
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Comment
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or, list second volunteer choice):
PLEASE READ AND AGREE TO WAIVER
PLEASE READ AND AGREE TO WAIVER - SUPERHERO SCRAMBLE LLC SPECTATOR & VOLUNTEER WAIVER, RELEASE OF LIABILITY,COVENANT NOT TO SUE & IMAGE RELEASE As a spectator or volunteer of a Superhero Scramble competition(s), race(s), related events (the "Event") and/or activities, I, ___, the undersigned, acknowledge, appreciate, and agree that: 1.There is a risk of injury and/or death from the activities involved in the Superhero Scramble and its related events and as a spectator or volunteer, I understand that there is a potential related risk to me due to my presence near the Events; 2.I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation as a spectator; 3.If I observe any unusual and/or significant hazard during my presence, I will remove myself from the area that I perceive as a hazard and shall bring such hazard to the attention of the nearest official; 4.I, for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE, Superhero Scramble, and their officers, directors, representatives, officials, agents and/or employees, subsidiaries, and/or assigns, as well as their independent contractors, sponsoring agencies, sponsors, advertisers, volunteers, and if applicable, owners and lessors of the premises used to conduct the Event (collectively, the "Releases"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, and/or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE Releases OR OTHERWISE. I further agree to indemnify, defend and hold harmless Releases from any loss, liability, cost, claim or damages arising from my participation in or association with activities and events organized and sponsored by Superheor Scramble or connected with the Events; 5.My attendance as a spectator or volunteer at the Events organized or sponsored by Superhero Scramble is entirely voluntary; 6.I consent to administration of first aid and other medical treatment in the event of injury or illness and hereby release and indemnify Releases from any and all liability or claims arising out of such treatment; 7.The Releases reserve the right, in its sole determination, to postpone, cancel, or modify the event due to weather conditions or other factors beyond the control of the Releases that might affect the health and/or safety of the participants; 8.I hereby grant permission gratis to the Releases to film, videotape and record gratis the performance of the above named participant (referred to herein as "I", "me", "my") as it relates to the Event and subsequently to telecast and otherwise utilize the same gratis in whatever manner Releases shall deem appropriate. Such permission shall include the unlimited right to appropriate use gratis by Releases of my name, nickname, image, likeness, voice, photograph, signature facsimile, and biographical information in connection with the Event. I acknowledge that Releases and their representatives shall have the unlimited right throughout the universe to copyright, use, reuse, publish, republish, broadcast and otherwise distribute all or any portion of the Event in which I may appear on any and all radio, network, cable and local television programs and in any print materials and in any other format or media (including electronic media) now know or hereinafter devised in perpetuity without compensation. In consideration and in return for being allowed to participate in the Event, I release and agree not to sue the Releases from all present and future claims regarding my participation in the Events that may be made by me, my family, estate heirs, or assigns. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. MINORS: IF UNDER 18 SIGNATURE OF PARENT OR GUARDIAN (required) The undersigned, __, referred to as the parent(s) and natural guardian(s) or legal guardian(s) of _, does hereby represent that he/she (they) is (are), in fact, acting in such capacity and agrees to indemnify, save and hold harmless each and all of the parties herein referred to above as Releases from all loss, liability, damage, cost or claim whatsoever that may be imposed upon said Releases because of any defect in or lack of such capacity to so act and release said Releases on behalf of the undersigned.
 
 
INFO FOR PARENT/GUARDIAN COMPLETING THIS REGISTRATION
Registration for minors must be completed by a Parent or Legal Guardian. If your age on race day is less than 18 years old, please fill in the Parent/Guardian Contact Information below. Providing such information and continuing this process indicates that this registration was completed by the person listed below.
Parent/Guardian Name:
Contact Phone:
Contact Relationship:
 
*Agree to waiver: I agree I do not agree