2019 Water Walk Waiver - Villages in Partnership

Name*
Enter the Participant's name, even if under 18 years of age. Please submit one (1) waiver per participant.
First Last
Email Address*
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Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Statement of Waiver & Consent*
I understand the risks involved in participating in the Water Walk, willingly accept these risks, and VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS OR PERSONAL INJURY that may be sustained by me as a result of being engaged in such an activity.

I attest that I am physically fit and prepared for this event. I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Villages in Partnership, its trustees, officers, servants, agents, and employees from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by me, WHETHER CAUSED BY THE NEGLIGENCE OF SUCH PERSONS, or otherwise, while participating in the Water Walk event, or while in, on or upon the premises where the Walk is being conducted.

I grant permission for the organization to use photographs/images, video footage, and quotations from me in accounts and promotions of this event.

Choose one.
- I am a PARTICIPANT 18 years of age or older; and I have read, understand and agree to the statement above.
- I am the PARENT or GUARDIAN of the Participant who is under 18 years of age; I have read, understand and agree to the statement above; and I acknowledge that this agreement is effective and binding upon myself and all members of my family, including the Participant stated above.
Signature*
By entering your name below and clicking "Submit," you are agreeing to the Statement of Waiver & Consent stated above.
If you are signing on behalf of a Participant under the age of 18, please sign YOUR NAME below, not the Participant's name.
Date*
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