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CONSENT AND RELEASE: PLEASE READ CAREFULLY BEFORE PROCEEDING!    
 
This Consent, Release and Waiver of Liability (the "Release") is hereby executed on the date written below by the undersigned participant or volunteer (the "Participant") in favor of the American Cancer Society, Inc., their affiliated divisions and entities, including in each case, without limitation, their directors, officers, employees, volunteers, and agents (collectively "ACS"). The Participant desires to fundraise on behalf of ACS and/or engage in certain activities and/or events with ACS ("Activities"), and understands that his/her participation in these Activities may include but are not limited to camping, picnicking, walking, jogging, running, bicycling, golfing, other recreational activities, and any other events or activities reasonably anticipated to be performed by Participant as a part of or in any way associated with ACS Activities. The Participant acknowledges that he/she derives personal satisfaction and a benefit by virtue of his/her participation with the ACS and/or performing the Activities discussed above, and Participant willingly engages in these Activities.   The Participant hereby freely, voluntarily, and without influence from anyone or duress of any kind executes this Release and consents and agrees to each of the following:   RELEASE AND WAIVER. THE UNDERSIGNED PARTICIPANT HEREBY RELEASES, WAIVES AND FOREVER DISCHARGES ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST ACS, INCLUDING ITS SUCCESSORS AND ASSIGNS, EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE, FAULT OR MISCONDUCT OF ANY KIND ON THE PART OF ACS FOR DAMAGES OR CAUSES OF ACTION, INCLUDING BUT NOT LIMITED TO DEATH, BODILY OR PERSONAL INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH PARTICIPANT, HIS/HER HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON THEIR BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM THE PERFORMANCE OF PARTICIPANT'S ACTIVITIES AND/OR PARTICIPATION WITH ACS ACTIVITIES.   ASSUMPTION OF THE RISK. The Participant understands that in conducting the Activities that Participant may choose to engage in physical activities that may be hazardous to the Participant, including but not limited to camping, picnicking, walking, bicycling, jogging, and running, and any other activities reasonably anticipated to be performed by Participant as a part of or in any way associated with ACS Activities, and hereby knowingly assumes the risk of injury, harm and loss associated with such physical activities.   WEB PAGE CONTENT. ACS provides web pages to participants ("Participant Pages") as a service. All donations received through the Participant Pages are contributions for which no goods and services have been provided. Therefore, Participant Pages shall not contain any language which suggests that merchandise will be provided in exchange for their contribution. Participants are expressly prohibited from offering merchandise sales, prizes, raffles, giveaways, lotteries, contests, tournaments, lucky draws, or any games of chance on their Participant Pages either as an outright token action or as an inducement to solicit donations. As a Participant, you are limited to disseminating information that is for the benefit of ACS. The Participant Pages are expected to represent ACS in a professional manner in accordance with the ACS Internet Privacy Policy. Furthermore, Participants are expressly prohibited from including information on their Participant Pages that are inconsistent with ACS's mission and values. Participant Pages shall not advertise for-profit business. Examples of prohibited subjects include, but not are limited to, the sale or promotion of any goods or services, an endorsement or perceived endorsement of any goods or services, support or opposition of a political party or a political candidate, materials affiliated with tobacco or tobacco-related products and any other products inconsistent with ACS's mission, content of any nature which may result in fraud or misrepresentation to the public, pornographic or otherwise offensive sexual materials, racially or ethnically prejudicial materials, overtly religious materials or any other information that may be offensive to the general public. ACS reserves the right to edit or remove any participant page that ACS deems in violation of these policies and standards.   IMAGE RELEASE. Participant does hereby grant and convey unto the American Cancer Society, Inc. all right, title, and interest in any and all photographic images and video or audio recordings made by the American Cancer Society, Inc. during the Participant's Activities with the American Cancer Society, Inc., including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. Participant hereby releases, discharges and agrees to save harmless ACS, its legal representatives or assigns, and all persons acting under its permission or upon its authority or for whom it is acting, from any liability by virtue of any publication of Participant's likeness, including, without limitation, claims for libel or invasion of privacy.   THE FOLLOWING MUST ALSO BE COMPLETED BY PARENT OR GUARDIAN IF PARTICIPANT IS A MINOR CHILD UNDER 18 YEARS OF AGE:   In consideration of the minor child's (under 18 years of age) (Minor Participant) participation in ACS Activities the undersigned in his/her capacity as Minor Participant's parent or guardian, hereby (a) give permission for the Minor Participant, who is my child or ward, to participate voluntarily in ACS Activities and/or perform the Activities referenced in the Release, and (b) understand that this Release forever releases, waives and discharges any and all liability, claims, and demands of whatever kind or nature against ACS, including ACS's successors and assigns, either in law or in equity, to the fullest extent permissible by law, including but not limited to the negligence, fault or misconduct of any kind on the part of ACS for damages or causes of action, including but not limited to death, bodily or personal injury, illness, economic loss or out of pocket expenses, or loss or damage to property, which Minor Participant, his/her heirs, assignees, next of kin and/or legally appointed or designated representatives, may have or which may hereinafter accrue on their behalf, which arise or may hereafter arise from the performance of Minor Participant's Activities and/or his/her participation in ACS Activities.   I also acknowledge reading and understanding all of the terms and conditions set forth in the Release signed by my child or ward, and consent and agree to each and every term and condition contained in the Release.   Checking the box below, and completing this registration does prove that you are consenting to the waiver & release of certain legal rights as set forth in this release and waiver of liability agreement.

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Funds raised through American Cancer Society Sole Burner of Appleton event support the American Cancer Society's fight to end cancer. Specifically, these dollars are used to make a difference in the following ways:

  • Helping people take steps to reduce their risk of cancer or find it early when it is most treatable
  • Investing in research to find, prevent, treat, and cure the disease
  • Providing free information and services to help people facing cancer today - when and where they need it - including transportation, lodging, wigs, support programs, and more
$25 – would help provide free access to 24-hour information and support for one person via the phone email, and online chats.
$50 – would help provide five rides to and from treatment for a cancer patient. 
$100 – would help provide a breast cancer patient with one-on-one peer support from a breast cancer survivor.

Must be registered prior to April 25, 2017 to be guaranteed an event shirt.

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Youth participant entries are $12.00 each.

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