Waiver
4th Dimension Racing LLC
5-10h and 24h Adventure Race
RELEASE, WAIVER OF LIABILITY AND ASSUMPTION OF RISK – READ CAREFULLY
In consideration for my participation in this 4TH DIMENSION RACING EVENT, I acknowledge that adventure racing is an inherently dangerous sport. I voluntarily choose to participate in adventure racing at my own risk AND UNDERSTAND THAT THE RISKS INCLUDE SERIOUS PERSONAL INJURY OR EVEN DEATH. I understand the risks inherent in each of the individual sports that comprise an adventure race, and also understand that those risks may be increased when the various sports are combined into a multisport event of longer duration. Aware of these risks, I hereby assume the risk of participating in this 4TH DIMENSION ADVENTURE RACING EVENT, and release and forever discharge the “Released Parties” (defined below) for all claims of any kind that I may have or later accrue because of my participation in this 4TH DIMENSION ADVENTURE RACING EVENT, INCLUDING CLAIMS ARISING FROM THE RELEASED PARTIES’ ORDINARY NEGLIGENCE.
I understand that the adventure racing is dangerous and requires sufficient skills in order to participate. I agree and represent that I or team participants have special training or expertise to compete safely in this event and that I am relying upon my own or my teams skill and expertise to compete in this event and not on any sponsor or organizer. I agree that I am not aware of any physical or mental problems that will hinder my ability to compete in this activity and that I am in good health.
The Released Parties include 1) 4th Dimension Racing LLC and its officers, directors, shareholders, employees, contractors, agents, volunteers or sponsors, and 2) each of the respective landowners and operators of lands, public and private, on which the event will take place, and each of their respective members, officers, elected officials, directors, shareholders, employees, agents or sponsors, and 3) City of Hoodsport , WA, and 4) Camp Cushman, and 5) Olympic National Forest Ranger District, and 6) Department of Natural Resources, 7) City of Tacoma, and 6) All other involved parties or participants.
I execute this release, waiver and assumption of risk on behalf of myself and my heirs, executors, legal representatives, successors and assigns. I waive all claims released by this agreement, and promise not to bring nor permit others to bring any such claims on my behalf, and agree to indemnify all of the parties released hereby against their respective costs of defending any such claims, including reasonable attorney fees. I also represent that I am solely responsible for and can be held liable for my health, actions, and behavior during this event. The undersigned hereby expressly agrees that this release and waiver is intended to be as broad and inclusive as permitted by the laws of the State of Washington and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I currently have no medical condition, physical or mental, that would impair my capacity to participate in adventure racing. I am at least 18 years old as of the date hereof. I hereby grant to 4th Dimension Racing LLC, and it assigns a global license to use photographs, videotape or other media of me participating in adventure racing, all at no cost or charge.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE WAIVER AND RELEASE OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or induction apart from the foregoing written agreement have been made. I understand that I have the right to have this Agreement reviewed by an attorney of my choice and after having been advised to do so, I hereby WAIVE my right to do so.
MEDICAL INFORMATION
Medical insurance plan: __________________________________________________________________
Physician’s name:______________________________________________________________________
Physician’s phone number:_______________________________________________________________
Medications (prescription and non-prescription) please list:______________________________________
Allergies (if any):______________________________________________________________________
Medical conditions or illnesses (Seizures, heart conditions, high blood pressure, diabetes, hypoglycemia, emphysema, arthritis, etc) please list:
_____________________________________________________________________________________
EMERGENCY CONTACT INFORMATION (name, address, home phone, work phone):
_____________________________________________________________________________________
I certify that I am physically fit and have sufficiently trained for participation in this event.
(Initial: ______)
I will be personally responsible for my own safety during this event and assume all risks and accept full and complete responsibility for any and all damages and personal injury of any kind, including death. . (Initial: ______)
This Agreement must be signed by all participants as a condition for participation, which in my opinion makes this Agreement a reasonable contract. I acknowledge that I have the right to have this Agreement reviewed by an independent attorney of my choice. After having been advised to do so, I hereby WAIVE my right to do so. (Initial: ______)
The undersigned acknowledges that he/she has read the foregoing paragraphs and is completely aware of the potential dangers incident to engaging in the event, and is fully aware of the legal consequences of signing this document and is signing the document under their own free will. (Initial: ______)
Signature: ________________________________________________________Date:_______________
Printed Name: _____________________________________________________Age:_______________
Address: _____________________________________________________________________________