TEAM CAPTAIN LAST NAME, FIRST NAME: ___________________________________

TEAM NAME: _______________________________________________________________

2011 MID-SOUTH MUD RUN 5K CHALLENGE TEAM WAIVER

DATE: _______________________________

By indicating your acceptance, you understand, agree, warrant and covenant as follows:

In consideration of the foregoing, I, for myself, my heirs, executors, and administrators, waive
and release any and all rights and claims for damages I have against the 2011 Fund Drive for
Navy-Marine Corps Relief Society 5K Mud Run Challenge at Naval Support Activity Mid-South
principals, Navy-Marine Corps Relief Society, United States Navy, all sponsors and their
representatives and any all claims against damages, demands, actions, whatsoever in any manner
as a result of my participation in 2011 Fund Drive for Navy-Marine Corps Relief Society 5K
Mud Run Challenge at Naval Support Activity Mid-South including but not limited to any
injuries I might suffer or damages to clothing or personal items. I acknowledge that I am aware
of the inherent risks in participating in an athletic event of this type. I attest and verify that I am
physically fit and have trained sufficiently for the competition of this event and my physical
condition has been verified by a licensed medical doctor. Further, I hereby grant full permission
to any and all of the foregoing to use my name, my voice, and or my picture in any broadcast,
telecast, advertising, promotion or other account of this event for any purpose whatsoever. I
further agree to have my name, email address, and mailing address released to sponsors and that
they are permitted to contact me about their products, services, or promotions related to fitness
events, with the understanding that they will not further release, sell, or transfer my information
to anyone else. I understand that the entry fee is non-refundable and individual numbers are non-
transferable. If you are under a physician’s care for any chronic condition you should check with
your physician before you begin training for the 2011 Fund Drive for Navy-Marine Corps Relief
Society 5K Mud Run Challenge at Naval Support Activity Mid-South and again before
participating in the 2011 Fund Drive for Navy-Marine Corps Relief Society 5K Mud Run
Challenge at Naval Support Activity Mid-South.

2. Waiver.
YOU UNDERSTAND THAT PARTICIPATION IN THE EVENT IS POTENTIALLY
HAZARDOUS, AND THAT A REGISTERED PARTY SHOULD NOT PARTICIPATE
UNLESS THEY ARE MEDICALLY ABLE AND PROPERLY TRAINED. YOU
UNDERSTAND THAT EVENTS MAY BE HELD OVER PUBLIC ROADS AND FACILITES
OPEN TO THE PUBLIC DURING THE EVENT AND UPON WHICH HAZARDS ARE TO
BE EXPECTED. PARTICIPATION CARRIES WITH IT CERTAIN INHERENT RISKS
THAT CANNOT BE ELIMINATED COMPLETELY RANGING FROM MINOR INJURIES
TO CATASTROPHIC INJURIES INCLUDING DEATH. YOU UNDERSTAND AND
AGREE THAT IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN THE
EVENT, YOU AND ANY REGISTERED PARTY, THE HEIRS, PERSONAL
REPRESENTATIVES OR ASSIGNS OF YOU OR THE REGISTERED PARTY DO HEREBY
RELEASE, WAIVE, DISCHARGE AND CONVENANT NOT TO SUE ACTIVE FOR ANY
AND ALL LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM PARTICIPATION
IN THE EVENT BY YOU OR ANY REGISTERED PARTY.

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TEAM CAPTAIN LAST NAME, FIRST NAME: ___________________________________
TEAM NAME: _______________________________________________________________

3. Severability. You further expressly agree that this Agreement and Waiver is intended to be as
broad and inclusive as is permitted by the law of the State of Tennessee and that if any provision
of this Agreement and Waiver shall be found to be unlawful, void, or for any reason
unenforceable, then that provision shall be deemed severable from this Agreement and Waiver
and shall not affect the validity and enforceability of any remaining provisions.

4. BY INDICATING YOUR ACCEPTANCE OF THIS AGREEEMENT AND WAIVER, YOU

ARE AFFIRMING THAT YOU HAVE READ AND UNDERSTAND THIS AGREEMENT
AND WAIVER AND FULLY UNDERSTAND ITS TERMS. YOU UNDERSTAND THAT
YOU ARE GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE. YOU
ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER
FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO BE A
COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST
EXTENT ALLOWED BY LAW.

[ ] Initials of participant over 18 years of age or parent/legal guardian of minor under

18 years of age or legal guardian of incapacitated and/or mentally challenged person.

RACE CATEGORY: TEAM OPEN / TEAM B&U (circle one)

FIRST NAME: ________________________________________________________________

LAST NAME: ________________________________________________________________

GENDER: M / F BIRTH DATE: _____________________________

EMAIL: ______________________________________________________________________

AGE ON RACE DAY: __________________________________________________________

T-SHIRT SIZE: XS / S / M / L / XL / XXL

ARE YOU: MILITARY / DOD CIVILIAN / CIVILIAN

IF MILITARY, WHAT BRANCH: _________________________________________________

IF YOU WORK AT NSA MID-SOUTH, WHAT COMMAND/CODE DO YOU WORK

WITH?
______________________________________________________________________________

PARTICIPANT SIGNATURE: ____________________________________________________

(Or parent/legal guardian of minor under 18 years of age or legal guardian of incapacitated
and/or mentally challenged person.)

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