Waiver Must Be Read and Signed:
PARTICIPANTS – PLEASE READ AND SIGN WAIVER FORM BELOW: I understand that my participation in this athletic activity involves the risk of injury to my person, as well as possible lost, stolen or damaged items. I personally hereby agree to assume the risks. It is further understood that there is no health or accident coverage for treatment of injuries experienced or incurred during this program or as a result of the program. I certify that I am in good health, at least 13 years of age and have no existing injury or illness which might limit my participation in this program. In the event that I become aware of any such condition, I will immediately notify the race director. For and in consideration of my ability to participate in this athletic program, I personally hereby release Friends of Drake Well, Inc., the City of Titusville, Drake Well Museum and Park, the Commonwealth of PA and Oil Creek State Park as well as all volunteers or employees participating in this program from any and all claims or causes of action that I might have against them for injuries to myself, damage or loss of personal property, resulting from my participation in this program. In further consideration of my ability to participate in this program I agree to hold the Friends of Drake Well, Inc., the City of Titusville, Drake Well Museum and Park, the Commonwealth of PA and Oil Creek State Park and all volunteers or employees, or any other personnel involved harmless from and against any and all causes of action claims or lawsuits that might be brought against any or all of them arising from or relating to any injuries sustained by myself as a result of participating in this athletic program. Said indemnity shall include court costs and reasonable attorney’s fees. This release shall extend to my heirs, personal representatives and assigns.
By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process.
YOUTH PARTICIPIANT 1). PARENTS: PLEASE READ AND SIGN WAIVER: I/We the parents (guardian of _________________________________________________________ hereby give my/our approval for his/her participation in the program to __________________________ _______________________ ______________________ Signature of Mother (date) Signature of Father (date) Signature of Guardian (date)
ADULT PARTICIPIANT 2). ADULT PARTICIPANTS – ______________________________________ PARTICIPANT’S SIGNATURE (date)