Name *
Name
Phone
Phone
Emergency Contact Phone Number
Emergency Contact Phone Number
Liability Waiver
Participant Liability Waiver: I, the undersigned participant in the 2017 Walk of Care, hereby release, waive, and forever discharge Rural Ottawa South Support Services (hereinafter referred to as “ROSSS”), their staff, Board of Directors, and volunteers, and all other bodies associated with ROSSS, and sponsoring companies, and any and all participating organization, entities, and/or venues and individuals, personnel, volunteers, and/or Board of Directors associated with these organizations/entities and/or venues of any claims, demands, damages, costs, expenses, actions, and causes of action, whether in law or equity, in respect of death, injury, loss or damage of my person or property howsoever caused, rising, or to arise by reason of my participation in the 2015 Walk of Care, whether as a spectator, participant, or otherwise, whether prior from, during, or subsequent to the event, and notwithstanding that same may have been contributed to, or occasioned by, the negligence of any of the aforementioned. I further hereby undertake or hold and save harmless and agree to indemnify all of the aforementioned from and against any and all liability incurred by any or all of them as a result of, or in any way connected with, my participation in the said event. By signing this waiver, I acknowledge having read, understood, and agreed to the above waiver, release and indemnity. I warrant that I am physically fit to participate in the event.