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RELEASE OF LIABILITY WAIVER (Adult) In consideration of the acceptance of this entry I waive all claims for myself and my heirs against the sponsors, cooperating and coordinating groups and any individuals associated with this event and will hold them harmless for any and all injuries which may result from my participation. I hereby give my permission to the media to use my name and photograph in the newspaper, broadcast, telecast of this event without limitation or obligation. I certify that I am physically fit for this event and understand the risks involved by participating in this event. Signature __________________________________ Date______________________________________       - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -     PARENT / GUARDIAN CONSENT FORM AND LIABILITY WAIVER Participant name _________________________________           Birth Date_____________________ Sex _______________   Parent/Guardian Name___________________________________________ Home Phone_____________________________________   I, ___________________________, grant permission for my child, ____________________________, to participate in the 5K Unity Walk/Run. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the 5K Unity Walk/Run, its officers, directors and agents, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the 5K Unity Walk/Run, its officers, directors and agents, or representatives associated with the activity for reasonable attorney’s fees and expenses arising in connection therewith. Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.     Signature_____________________________________ Date______________________________

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Street Works is one of Tennessee’s leading HIV service organizations, providing free, confidential HIV testing and supportive services to persons living with HIV disease in the Nashville/Middle Tennessee area since 1997. Street Works is a 501(c)(3) nonprofit which receives state, local, and federal funding to provide the following services: prevention, education, HIV and Hepatitis C testing, Medical Case Management, Housing Case Management, Nutritional Services, Emergency Financial Assistance and Early Intervention Services. In addition, Street Works offers services to young African American Men who have sex with men (MSM) through Project UNO, U New and Outstanding, which is located in Midtown. Street Works has two other Nashville locations, James Cayce Homes in East Nashville and Tony Sudekum Homes in South Nashville. Street Works Prevention Staff work the streets at night to prevent and reduce HIV disease and STIs on the inner city streets of Nashville. Our motto is: “We doze but we never close.” 

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