WAIVER

If the entrant is under 18 years of age, a parent/guardian must sign this Waiver Form. The parent/guardian consents to the entrant’s participation in the event and acknowledges that he/she is bound by this Waiver Form to the same extent as the entrant. In consideration of the acceptance of my application and the permission to participate as an entrant or competitor in the Colleen Lantz Memorial Run 4 Youth to be held on Saturday August 11, 2012, I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE, Colleen Lantz Memorial Run 4 Youth Inc., the Colleen Lantz Memorial Run 4 Youth Volunteer Team, the private landowners, the County of Grey, The Municipality of West Grey, The Ontario Track and Field Association, The Ontario Roadrunners Association, and all other associations, sanctioning bodies, and sponsoring companies, and all their respective directors and officers, agents, officials, servants, contracto rs, representatives, successors and assigns OF ALL AND FROM ALL claims, demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in the said event, whether as a spectator, participant, volunteer, or otherwise; whether prior to, during or subsequent to the event AND NOTWITHSTANDING that same may have been contributed to or occasioned by the negligence of any of the aforesaid. ATTESTATION: I attest and verify that I am fully aware of the physical risk of injury or death in participating in this event and voluntarily agree to accept full responsibility and legal liability for the same, that I am fit and have trained sufficiently for this event. I am also aware that the weather conditions on Saturday August 11, 2012 may be unpredictable thus posing an increased physical risk. By submitting this entry, I acknowledge having read and agreed to this waiver, release indemnification and attestation. I consent to the free use of my name and picture on broadcasts, telecasts, and the press as they pertain to the Colleen Lantz Memorial Run 4 Youth event. I permit the event directors, the sponsors and the charity free use of my name, voice and picture in any broadcast, advertising, promotion or other account of the event. I consent to the collection of my personal information on this form and to any photographs and video recordings of me during the event. The Colleen Lantz Memorial Run 4 Youth Inc. may use my personal information to process my entry form and record my results and to promote the event. The Colleen Lantz Memorial Run 4 Youth may publish the results in newspapers and on the internet.