BAL VIHAR 5K WALK/RUN April 6, 2014 Millennium Park, Creve Coeur

1. BAL VIHAR 5K WALK/RUNApril 6, 2014Millennium Park, Creve Coeur WAIVER AND RELEASE I hereby declare, assert and affirm that my participation in the Center of Indian Cultural Education, BalVihar of St. Louis, 5K Walk/Run is done voluntarily and knowingly, assuming ALL RISKS involved in this Event. I hereby certify the following: I am physically fit and have received medical clearance to participate in the Run/Walk. I recognize that the immediate physical risks and hazards associated with normal, vigorous physical activity include (but are not limited to) physical discomfort, fatigue, muscular soreness, falls, pulled or strained muscles, overuse injuries, heat stress, and the rare instance of abnormal responses of the cardiorespiratory system including heart arrhythmia, heart attack, stroke, and sudden death. If I do participate, I, on behalf of myself, my heirs and assigns, and my estate, hereby Waive and Release and forever discharge the sponsors, organizers, affiliates specifically Center of Indian Cultural Education, BalVihar of St. Louis, their respective volunteers, as well as their agents and employees, from any and all claims that may occur as a result of my participation. I hereby give my permission to the event organizers and sponsors to use my name and/or picture in any publication, broadcast, telecast or other account of this event without limitation or obligation of further compensation thereof. By signing this waiver and release I certify that I fully understand its significance. Registration Form: 1K 3K 5K 5K+ Participant 1: _________________ ___ ___ ___ ___ Participant 2: _________________ ___ ___ ___ ___ Participant 3: _________________ ___ ___ ___ ___ Participant 4: _________________ ___ ___ ___ ___ Participant 5: _________________ ___ ___ ___ ___ Participant 6: _________________ ___ ___ ___ ___ Participant 7: _________________ ___ ___ ___ ___ _______________________________ Date _________ / _____________________________ Date_________ Participant #1 signature If under 18, Parent or Guardian’s signature _______________________________ Date _________ / _____________________________ Date_________ Participant #2 signature If under 18, Parent or Guardian’s signature _______________________________ Date _________ / _____________________________ Date_________ Participant #3 signature If under 18, Parent or Guardian’s signature _______________________________ Date _________ / _____________________________ Date_________ Participant #4 signature If under 18, Parent or Guardian’s signature _______________________________ Date _________ / _____________________________ Date_________ Participant #5 signature If under 18, Parent or Guardian’s signature _______________________________ Date _________ / _____________________________ Date_________ Participant #6 signature If under 18, Parent or Guardian’s signature