Program Consent, Release, Terms, Conditions and 5K Waiver
I am the parent/legal guardian of the Participant named above, a minor. I agree that the minor child may participate in the Spark Her Stride program. The purpose of the program is to empower 7-11 year old girls in the Harrisonburg, VA community through healthy activity (running), role modeling, and a welcoming environment for all levels of ability. I understand that during the program, the Participant will be involved in outdoor physical activities. Physical reactions to exercise may include heat-related illness, abnormal heartbeats and blood pressure and, in rare instances, events such as heart attacks. While Spark Her Stride takes all reasonable precautions, we can make no guarantees regarding these and other risks. Recognizing the risks of the program, and in consideration for allowing the Participant to participate in the program, I hereby release, discharge and agree to hold harmless, and to indemnify each of Spark Her Stride and VA Momentum, their owners, directors, officers, contributors, sponsors, employees, contractors, volunteers, agents and assigns against and from any causes of action, claims, demands, damages, costs, loss of services, expenses, compensation, all consequential damages and attorneys' fees (regardless whether pursuant to the laws of any county, state or country) claimed by, through or on behalf of me or the Participant related directly or indirectly to the program (including without limitation the Valley 4th RUN), and specifically including any and all claims for personal injuries sustained while participating in program activities without regard to negligence or negligent conditions.
In addition, I hereby authorize Spark Her Stride and VA Momentum, if after a reasonable attempt has been made to reach a parent/guardian or emergency contact to obtain consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the Participant under the general or special supervision and on the advice of any physician or surgeon who may treat the Participant, and consent to any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment and hospital care, to be rendered to the Participant by any health care professional who may treat the Participant. I agree to pay for any such treatment and to reimburse Spark Her Stride and VA Momentum for all costs and expenses it may incur related to such treatment.
Photo Release: I hereby grant to Spark Her Stride and VA Momentum the absolute and irrevocable right and permission, in respect of the photographs and videos that have been or will be taken of the Participant or in which the Participant may be included with others, to copyright the same, in the name of Spark Her Stride and VA Momentum or otherwise; to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs and videos, and in conjunction with any printed matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in connection therewith. I hereby release and discharge Spark Her Stride and VA Momentum from any and all claims and demands arising out of or in connection with the use of the photographs and videos, including without limitation any and all claims for libel or invasion of privacy.
Authorization: I expressly agree that this consent is intended to be as broad and inclusive a release of liability as permitted by applicable law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I hereby warrant and represent that I am 18 years old or older; I have carefully read this consent and agree to its terms and conditions, that before signing this agreement I had the chance to ask questions; and I am aware that by signing this consent, I assume all risks and waive and release certain substantial rights that I and Participant may have or possess against Spark Her Stride and VA Momentum.
I have fully read the above permissions, policies, and releases. I understand them and I expressly agree to them. I hereby certify that there are no contraindications to the Participant's participation in the Spark Her Stride program. I am the parent or legal guardian of the Participant, and this permission and release is binding on me and my executor, administrators and heirs.
In addition, I hereby authorize Spark Her Stride and VA Momentum, if after a reasonable attempt has been made to reach a parent/guardian or emergency contact to obtain consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the Participant under the general or special supervision and on the advice of any physician or surgeon who may treat the Participant, and consent to any x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment and hospital care, to be rendered to the Participant by any health care professional who may treat the Participant. I agree to pay for any such treatment and to reimburse Spark Her Stride and VA Momentum for all costs and expenses it may incur related to such treatment.
Photo Release: I hereby grant to Spark Her Stride and VA Momentum the absolute and irrevocable right and permission, in respect of the photographs and videos that have been or will be taken of the Participant or in which the Participant may be included with others, to copyright the same, in the name of Spark Her Stride and VA Momentum or otherwise; to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs and videos, and in conjunction with any printed matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in connection therewith. I hereby release and discharge Spark Her Stride and VA Momentum from any and all claims and demands arising out of or in connection with the use of the photographs and videos, including without limitation any and all claims for libel or invasion of privacy.
Authorization: I expressly agree that this consent is intended to be as broad and inclusive a release of liability as permitted by applicable law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I hereby warrant and represent that I am 18 years old or older; I have carefully read this consent and agree to its terms and conditions, that before signing this agreement I had the chance to ask questions; and I am aware that by signing this consent, I assume all risks and waive and release certain substantial rights that I and Participant may have or possess against Spark Her Stride and VA Momentum.
I have fully read the above permissions, policies, and releases. I understand them and I expressly agree to them. I hereby certify that there are no contraindications to the Participant's participation in the Spark Her Stride program. I am the parent or legal guardian of the Participant, and this permission and release is binding on me and my executor, administrators and heirs.
