Acknowledgement of Responsibility and Release of Liability

The Syracuse-Wawasee Park Foundation, Inc. is offering a Beginners 5k run/walk Program to the public in order to help you achieve your fitness goals. Before beginning any exercise program, you should consult with your physician. Exercise is an activity in which, despite careful and proper preparation, instruction, medical advice, conditioning, and equipment, there can still a substantial risk of injury. Please read this form carefully and be aware that by participating in this program you will be waiving your rights to all claims for any injuries you might sustain arising out of this use, and you will be required to indemnify, hold harmless and defend the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities for any claims arising out of participation in said program(s).

I agree to the following provisions.

Acknowledgement of Responsibility: I acknowledge and agree that I am responsible for my own safety, health and welfare in participating in this program.
Risk of Injury: As a participant in the program, I recognize and acknowledge that exercise carries the risk of physical injury, and I agree to assume the full risk of injuries, including death, damages, or loss which I may sustain as a result of my participation in this program. I understand that my participation is voluntary, and that I am choosing to accept the risks involved.
Waiver and Release of Liability: In consideration of my participation in this program, I agree on behalf of myself, my heirs and assigns, to waive, release and forever discharge Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities from any and all claims of negligence or other actions, whether foreseeable or unforeseeable, which may at any time arise out of or relate to my participation in this fitness program. This waiver and release of liability includes, but is not limited to, injuries which may occur as a result of a) my use of any exercise equipment or facilities, b) improper maintenance of any exercise equipment or facilities, c) negligent instruction or supervision, and/or d) slipping and falling while on the premises. I ACKNOWLEDGE THIS IS A WAIVER OF ALL CLAIMS, INCLUDING CLAIMS ARISING FROM THE NEGLIGENCE OF SYRACUSE-WAWASEE PARK FOUNDATION, INC., MEGAN MCCLELLAN, THE LAB, LYLE SCHROCK AND ANY OTHER ASSOCIATED ENTITIES.
Indemnity: I further agree to indemnify, hold harmless and defend Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities, their officers, agents, and employees from any and all claims related to injuries sustained by me and arising out of, connected with, or in any way associated with the activities of the program.
Agreement Not to Sue: I agree on behalf of myself, my heirs and assigns not to sue the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities for any reason related to my participation in this program.
Emergency Treatment: In the event of any emergency, I authorize the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities to secure any treatment deemed reasonable and necessary, and agree that I will be responsible for payment of any and all medical services rendered.
Consent to Photograph: I grant and assign to the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, and Lyle Schrock a non-exclusive, royalty-free license to use any and all photographs, videotapes, digital images and audio recordings taken of me and/or my minor child by or for representatives of the system. I understand and agree that this material may be used in one or all of the following:

Radio/Television broadcasts
Newspaper/Magazine articles
Print Materials/Advertisements
Web Site/Internet

This consent to photograph will not expire until such time as the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, and Lyle Schrock no longer desires to use or disclose the information described above for the general purpose for which this consent was obtained. You may revoke this consent, and if you wish to do so, you may send a letter to the Megan McClellan, 1013 N. Long Dr, Syracuse, IN 46567.

I have been given ample time to read this Acknowledgement and Release, and I have read and fully understand its contents. I understand that it is a release of liability and an acknowledgement of responsibility, and by checking the box below, I know that I am waiving any right to bring a legal action against the Syracuse-Wawasee Park Foundation, Inc., Goshen Health, Megan McClellan, The Lab, Lyle Schrock and any other associated entities for any claim relating to my participation in this program.

Couch to 5k