Bring this completed form to a drop off location by November 24th
City, State, ZIP: _______________________________________________________
Phone: _____________________ EMail: ___________________________________
Gender: M F Age on Race Day: _______
T shirt size: XS S M L XL XXL
Register me for: _______ 4 mile run $30
_______ 2 mile fun run $25
STAR, Progressive Components, Wauconda Park District, Wauconda Fire District and the Village of Wauconda are mutually committed to conducting recreation programs and activities in a safe manner and holds the safety of participants in high regard. STAR, Progressive Components, Wauconda Park District, Wauconda Fire District and the Village of Wauconda continually strive to reduce such risks and insist that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for this program/activity must recognize that there is an inherent risk of injury when choosing to participate in recreational activities.
You are solely responsible for determining if you or your minor child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.WARNING OF RISK
Recreational activities/programs are intended to challenge and engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity/program. Understandably, not all hazards and dangers can be foreseen. Depending on the particular activity, participants must understand that certain risks, dangers and injuries due to inclement weather, slips and falls, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, premises defects, inadequate or defective equipment, inadequate supervision, instruction or officiating, and all other risks inherent to indoor and outdoor recreational activities/programs exist. In this regard, it must be recognized that it is impossible for the STAR, Progressive Components, Wauconda Park District, Wauconda Fire District and the Village of Wauconda to guarantee absolute safety.WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity (including transportation services and vehicle operations, when provided).
I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the STAR, Progressive Components, Wauconda Park District, Wauconda Fire District and the Village of Wauconda, including their respective officials, officers, employees, and volunteers (hereinafter collectively referred as “Parties”).
I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with this program/activity.
I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.
Participant’s Name Participant’s Signature
(18 years or older or Parent/Guardian)
Signature of Participant: _________________________________________________
Signature of parent (if under age 18): ______________________________________
Checks payable to: STAR Charities
Mail to: STAR, 236 N Main Street, Wauconda, IL 60084