(Must be signed by entrant, parent or legal guardian).
I know that running a race is a potentially hazardous activity and I should not enter this event unless I am medically able and properly trained. I realize the course presents a number of potential dangers to me and I assume all risks associated with this event. I realize I will be running on a number of different surfaces, such as, but not limited to, asphalt, concrete, grass, gravel, and hills. In consideration of my participation in this event, I, for myself, my heirs, executors, personal representatives, administrators, assigns or anyone entitled to act on my behalf, waive and release the organizers, volunteers, sponsors, Concordia Lutheran High School, Veep Races LLC, eRunner Timing & Results, Running Around Screen Printing, City of Fort Wayne, Fort Wayne Parks and Recreation, Allen County Board of Commissioners, Concordia Junior Reserve Officer Training Corps, Indiana University Purdue University Fort Wayne (IPFW), and the Road Runners Club of America from all claims and liabilities, actions, demands or damages of any kind arising out of my training or participation in this event. I understand that strollers, dogs, and audio headsets are prohibited. I authorize my likeness to be used for any lawful purpose. My application for entry may be refused in the sole discretion of the race organizers and I understand that there are no refunds in the event of cancellation due to severe weather or as a result of a natural or manmade emergency. In the event of my injury or illness during the race, I waive confidentiality under Health Insurance Portability and Accountability Act (HIPPA) and direct that emergency medical personnel, physicians, clinics, hospitals or other medical personnel release my name, nature of injury and illness and extent of treatment to the Race Director. I permit my photograph, video recording or other representation of my likeness be used for promotion of the race or any other lawful purpose.