Agency/School________________________________. City, County ... audio tapes and/or digital recordings of any kind, taken
2017 Florida Law Enforcement Torch Run Volunteer/Runner Registration Form (For Guardian Ad Litem and Parent/Legal Guardian of Participants Under 18 Years of Age)
Agency/School________________________________ City, County __________________________________ Phone (W)____________________________________
[ ] Yes - I Will Be a Runner (YOU MUST SIGN WAIVER BELOW)
SPECIAL OLYMPICS FLORIDA, INC. RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY 2017 FLORIDA LAW ENFORCEMENT TORCH RUN In consideration of participating in the 2017 Florida Law Enforcement Torch Run, I (Guardian) represent that I understand the nature of the event and that the Minor is qualified, in good health, and in proper physical condition to participate in such event. I acknowledge that if on the event the conditions are unsafe, I will immediately discontinue the Minor’s participation in the event. I fully understand the event involves risks of serious injury, including permanent disability, paralysis and death, which may be caused by the Minor’s own actions, or inactions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the releasees named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully understand and assume all such risks and all responsibility for losses, cost, and damages I incur as a result of the Minor’s participation in the event. Special Olympics may photograph or otherwise record the Minor while at the Event and that all such photographs, video tapes, audio tapes and/or digital recordings of any kind, taken or recorded of Minor by Special Olympics in connection with Minor’s attendance at or participation in the Event, or in connection with any publicity and/or promotional appearances relating thereto, shall be the exclusive property of Special Olympics. Special Olympics may use photographs or other recordings for any legal promotional purpose associated with the Special Olympics. Guardian hereby further agrees to release and discharge Special Olympics Florida, Inc., Special Olympics, Inc., their parents, subsidiaries, insurers, directors, officers, employees, volunteers, agents, successors and assigns (collectively, the “Sponsors”) from any claims, actions, damages, demands, costs, expenses (including attorneys’ fees) or lawsuits by reason of the sale or use of such photographs or recordings, whether caused by the negligence of the Sponsors or otherwise. I hereby release, discharge, and covenant not to sue Special Olympics Florida, Inc., their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the Releasees herein) from all liability, claims, demands, losses, or damages on the Minor’s account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations; and I further agree that if, despite the release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes claim against any of the releasees, I will indemnify, save, and hold harmless each of the releasees from any loss, liability, damage, or cost which may occur as the result of such claim. I have read this release and waiver of liability, assumption of risk, and indemnity and fully understand it.
Signature of Guardian: ___________________________________________ Printed Name of Guardian: ________________________________________ Printed Name of Minor Participant: _________________________________
Date: _____________
