2nd Annual Culver City Healthy Family 5K Run/Walk

Consent for minor under age of 18: I hereby give permission for the minor in my custody to participate in the Culver City Healthy Family 5K Run/Walk 2016 activity and hereby waive, release and discharge any and all claims or rights to claims for damages for death, personal injury or property damage which I may have or which may hereafter accrue to me, as a result of said minor's participation in said activity. This Release is intended to discharge in advance the promoters, sponsors, the City of Culver City, the officials and any involved municipalities or other public entities (and their respective agents and employees), from and against any and all liability arising out of or connected in anyway with said minor's participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that serious accidents occasionally occur during said activity, and that participants in such activity occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risks of said activity, nevertheless, on behalf of said minor child, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who, through negligence or carelessness, might otherwise be liable to me, or my heirs or assigns for damages. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to accept and abide by the rules and regulations of the City of Culver City. I give my permission to the City of Culver City to photograph me or my children participating in the programs for use in City of Culver City publicity and publications and I will not seek compensation for such use. Anyone over age of 18: I agree to assume full responsibility for all risk of bodily injury or loss of life which may result from my participation in the Culver City Healthy Family 5K Run/Walk 2016 . I attest and verify that I am physically and mentally able to participate in Parks, Recreation & Community Services activities, programs, and trips. I have consulted a licensed, trained medical doctor prior to signing this document. Furthermore, I hereby agree to hold harmless, release and forever discharge the City of Culver City, members of its elected or appointed boards or commissions, its officers, agents, volunteers and employees from any and all liability, claims or demands whatsoever which may arise as a result of my participation in any programs, trips or other activities at, sponsored by, organized by or otherwise affiliated with the Parks, Recreation & Community Services Dept. This Release is intended to discharge in advance the City of Culver City, members of its elected or appointed boards or commissions, its officers, agents and employees from and against any and all liability arising out of or connected in any way with my participation in said activities, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I understand that mortal or personal injury and/or property damage can occur as a result of participating in any of the programs, trips or other activities at, sponsored by, organized by or otherwise affiliated with the Parks, Recreation & Community Services Dept. Knowing and acknowledging these risks, nevertheless, I hereby voluntarily agree to assume those risks and to release and hold harmless the City of Culver City, members of its elected or appointed boards or commissions, its officers, agents, volunteers and employees from any and all claims or demands whatsoever which may arise as a result of those risks. I give my permission to the City of Culver City or anyone acting on the City’s behalf to photograph me as I participate in any programs, trips or other activities at, sponsored by, organized by or otherwise affiliated with the Parks, Recreation & Community Services Dept. Any of these photographs will become the property of the City of Culver City. I hereby agree that any of these photographs can be used by the City of Culver City for publicity and/or promotional purposes and that I will not seek compensation for such use. It is further understood and agreed that this release, assumption of risk, and waiver of publicity rights is to be binding on my heirs, assigns, executors, administrators and any other family members. I agree to accept and abide by the rules and regulations of the City of Culver City. SecureFee™ Registration Cancellation Insurance is offered in most states. If purchased, your registration may be covered for one of the covered reasons stated in the policy.